Adrenal Fatigue

Unraveling Adrenal Fatigue

In this insightful podcast Dr. McMinn and Coach Lindsay, along with special guest Rachel Olsen, will delve into the science of adrenal fatigue.  We will break down the controversy surrounding this important subject, and  we will explore how it influences various aspects of our physical, mental and emotional well-being. 

We will also explain why the term "adrenal fatigue" is somewhat of a misnomer, and that the term HPA Axis Dysfunction is a more accurate and descriptive name for  what is really going on with these patients.  By reviewing the mainstream medical literature we will demonstrate that this is a legitimate disease, causing very real symptoms, despite the fact that this condition is often not recognized by the mainstream medical establishment. 

 In this podcast listeners will gain a comprehensive understanding of the HPA axis. We discuss the physiology, as well as the symptom, work-up, diagnosis, and treatment of HPA axis dysregulation.    We  also share with our listeners a wide range of stress management strategies, resources, as well as nutritional, medical, and many other approaches to help our listeners address the challenges  posed by HPA axis dysfunction. 

So,  tune in to gain actionable insights, and to  embark on an evidence- based journey toward better health and resilience in the face of modern day stress. 

Chapters

• 0:00 HPA Axis Dysregulation in Functional Medicine
• 12:47 Understanding the Fight Flight Freeze Response
• 19:37 HPA Axis Dysfunction and Its Symptoms
• 25:38 Testing and Treatment for Adrenal Fatigue
• 32:56 Stress-Related Conditions and Treatment Options
• 44:12 Recommended Lifestyle Changes and Practices
• 55:05 Breakfast Recommendations and Nutrition Advice
• 1:05:00 Treating HPAD With Cortisol and Adaptogens
• 1:13:30 Exploring POTS Syndrome and Stress Management
• 1:17:05 McMinnMD.com

Transcript

Speaker 1: 0:00

Welcome to the Functional Medicine Podcast with Dr McMinn and Coach Lindsey. We're coming to you from McMinn Clinic in Birmingham, alabama, where Dr McMinn is an integrative in functional MD and Lindsey Matthews is a registered nurse and IIN certified health coach. In this podcast, we'll be discussing the latest information on a wide range of topics in the field of functional medicine, which looks for the root cause of disease, and integrative medicine, which incorporates both conventional and alternative therapies. Our overall goal is to help you be the best that you can be in mind, body and spirit. The following discussion is for educational purposes only and is not intended to diagnose or treat any disease. Please do not apply any of this information without approval from your personal doctor. And now on to the show with Dr McMinn and Coach Lindsey.

Speaker 2: 0:50

Hello and welcome to the Functional Medicine Podcast. We're here to share with you evidence-based and up-to-date information on matters related to integrative and functional medicine, along with practical take-home solutions so you can live a life of health and be more vibrant, have an optimized life and mind, body and spirit. We thank you for joining us today. I'm Dr Jim McMinn and I'm here with our co-host and certified health coach, nurse Lindsey Matthews. Welcome back, coach. We missed you the last couple of shows and we're glad to have you back.

Speaker 3: 1:17

Thank you. It feels great to be back on the show.

Speaker 2: 1:21

Our topic today is a dream of fatigue and Coach Lindsey and I will break it down for you in simple terms. And we have a very special guest today to help us make sense of this complicated, interesting and important topic. So if you've been feeling stressed out, wired but tired, so stay tuned and we have practical, proven solutions for you.

Speaker 3: 1:38

Yes, and we're really excited to bring someone back our friend and colleague, rachel Olson, a certified functional nutritionist. Rachel did an excellent podcast with us previously on nutrition, so you might want to dial back and check that podcast it's number 10, and listen to it. Lots of folks really loved it. I myself really enjoyed it and pumped to have your wisdom back on the show with us today. Well, thank you for being here.

Speaker 4: 2:02

Thank you for having me. I'm very glad to be here.

Speaker 2: 2:05

Great, great, great. So before we move on to our subject, just a quick reminder that our podcast is commercial free, which these days is unusual and, I think, refreshing. I'm a podcast listener too and, oh my gosh, those ads get a little bit annoying sometimes. But anyway, since we are commercial free, consider making a contribution, kind of like public radio, so we can keep this important, evidence-based, unbiased information coming to you.

Speaker 3: 2:25

There are a couple of ways that you can contribute. First, we're not asking you to buy any supplements that you don't already take, but if you do buy nutritional supplements, then consider purchasing supplements from our full script dispensary, where you can get a 10% discount. You can see a link to the full script below in the show notes. It's really quite simple. Click on that link and they'll guide you through the process. It's a win-win for everybody you get those supplements and it's a discount, and then you can support our show, help us keep this information coming to you. So thank you in advance for thinking about us with that.

Speaker 2: 3:00

And you can also make a contribution to the show directly via credit card or PayPal at the support the show link, which is also in the show notes below and don't forget to subscribe to the show so you will get notified when we have the new shows popping out. And one last thing it would be very grateful if you would give us a 5-star rating on the show. These really do help. If you don't know how to do this, then check out McMintMDcom slash reviews for detailed instructions.

Speaker 3: 3:23

And now, with the business stuff behind us, let's get on to the show, dr Mack.

Speaker 2: 3:28

Right. So let me start by saying right up front that adrenal fatigue is a very controversial subject. I'll do my best to explain why, but we're going to try to make sense of it for you. If you went to your average typical primary care provider and complained about adrenal fatigue, at best she would probably have a blank look on her face. At worst she would assume that you're a crazy quack and you've been visiting Dr Google too much. She would then probably tell you that there is no such thing as adrenal fatigue.

Speaker 3: 3:55

However, part of the confusion just comes from semantics itself. Words matter. The problem is similar to, you know, when we've talked about leaky gut in the past. If you went to your GI doc and complained of leaky gut, they would probably say there's no such thing. However, if instead you use the term intestinal permeability for the exact same thing, then she would understand where you are coming from and might even think that you're a little smarter than the average Joe out there.

Speaker 2: 4:24

And likewise with adrenal fatigue. Most doctors just can't relate to the term adrenal fatigue, since they've probably never heard of it. I guarantee that none of them study this in medical school. However, if you use the term instead HPA axis dysregulation or HPA axis dysfunction for the same condition, then most doctors will at least understand where you're coming from, since they have at least heard of that.

Speaker 3: 4:46

You know, to be honest, the term adrenal fatigue doesn't really accurately describe what's going on. It's not like your adrenal glands sitting on the top of your kidneys are just really tired and need to take a nap. It's really even misleading to think about that, since the bottom line truth of the matter is that the adrenal glands are not really fatigued at all. Right, dr McBeth?

Speaker 2: 5:04

That's correct. But even though your adrenals are not fatigued and the name adrenal fatigue is poor and misleading there is a very real condition that's going on here with these patients. The symptom complex that affects these patients is more accurately described by the term HPA axis dysregulation or HPA axis dysfunction In this case. Let me be clear here the H is for the hypothalamus, the P is for pituitary and the A stands for adrenal, which then adds up to hypothalamus pituitary adrenal axis.

Speaker 3: 5:38

And the condition is very real. These people are truly suffering. The patients are not going crazy and they're not just depressed Boy. My husband heard that before here's some antidepressant.

Speaker 3: 5:52

But at the end of the day the problem is not primarily an adrenal problem. Instead it's really a stress-induced brain problem. The real action is upstairs, Some where the hypothalamus and the pituitary are located. The effect on the adrenals is just secondary, it's downstream. The adrenals are not fatigued, they're just dutifully following the instructions of what's going on upstairs, the master control center, which is the hypothalamus. So remember that old saying we have said multiple times the body is a puppet of the mind.

Speaker 2: 6:22

Yeah, I love that saying it comes from Chinese medicine, which is kind of cool. But here's what happens Certain psychosocial, emotional and physical stressors alert the hypothalamus, which is the master control center of the brain, and this sends signals out to the pituitary gland, which is right next door in the brain, and the pituitary gland then sends signals all the way down to the adrenal glands, which are located down in New York kidneys, to tell the adrenals to secrete its stress hormones, adrenaline and cortisol. So let me emphasize and summarize the main take-home message here, because this is really important and it's at the heart of the confusion around this issue. This is really a stress-induced brain issue. It's not primarily an adrenal issue, and that's one of the names. Adrenal fatigue is inaccurate and misleading.

Speaker 3: 7:04

HPA access. Dysregulation can go both ways, so we can have high cortisol or we can have low cortisol, depending on the timing and the severity of the stressor. Initially, with the acute stress, the adrenals secrete a lot of cortisol to help our bodies survive the acute threat. But if that stress is chronic, then our adrenals continue to kick out the cortisol for quite a while and with these people they start to develop symptoms that correlate with high cortisol. Since just about every cell type in the body has cortisol receptors, then the effects are wide-ranging throughout your whole body and those symptoms could include things like fatigue, anxiety, weight gain, irritability, headaches, high blood pressure, low libido, menstrual irregularity, poor sleep, and that's just a few.

Speaker 2: 7:53

Yeah, and the master control center the hypothalamus, is really pretty smart is constantly monitoring how much cortisol we have in our blood via something called a feedback loop. It knows that too much cortisol over a long period of time is not good for you, so it starts to slowly put the brakes on. It sends signals down to the adrenal glands that enough is enough and it begins to downregulate the production of cortisol by the adrenal glands.

Speaker 3: 8:16

So we gradually transition from high cortisol to low cortisol, with a different but overlapping set of symptoms. The symptoms of low cortisol include fatigue, anxiety, depression, wake and immune system, brain fog, weakness, weight loss, muscle and joint pain, inflammation, difficulty getting out of bed in the morning. This is the people that gotta have the coffee right. Never waking up, feeling refreshed, needing a nap throughout the day and then trouble getting to sleep at night. So they're waking up in the middle of the night. Salt cravings, low blood sugar, low blood pressure, lightheadedness, maybe even fainting. Delayed recovery from illness and injury Could also be severe PMS and just less enjoyment in life in general. Dehydration, low libido, insomnia, again reduced exercise tolerance, so just inability to actually exercise and then just feeling less resilient and constantly overwhelmed or irritable. Symptoms are usually worse if the meals are skipped to you or you don't have adequate nutrition.

Speaker 2: 9:17

And this is sort of the classic picture of low or high cortisol state, which is what we've called adrenal fatigue in the past. But the important take home point here is that the vast majority of people with this documented low cortisol, who had the classic symptoms for this condition, or what we call adrenal fatigue, in the past, have perfectly normal functioning adrenal glands.

Speaker 3: 9:41

The low cortisol is not because again, because the adrenal glands have become fatigued or exhausted, as the name suggests adrenal fatigue or adrenal exhaustion. It's just that the adrenal glands are responding to brain signaling from the hypothalamus via this feedback loop system and that's telling them to reduce the cortisol production.

Speaker 2: 10:01

So since this term is somewhat of a misnomer of the condition, ie adrenal fatigue, and it's contributing to confusion around the issue, then the term adrenal fatigue seems to be falling out of favor. It's gradually being replaced with terms that more accurately describe what's really going on here.

Speaker 3: 10:16

So a couple of terms that seem to be gathering some momentum these days are HPA access dysregulation and HPA access dysfunction. A commonly used abbreviation for this is HPAD. So, moving forward, this is what you'll hear us call it on the podcast today HPAD or HPA access dysregulation.

Speaker 2: 10:40

And, as a side note, it could really be called HPA-TG dysregulations, with the T standing for thyroid and the G standing for gonads. This takes into account that the thyroid gland and the sex glands called the gonads, which include ovaries and testes, are also affected by the same dysregulation. However, that term becomes somewhat unwieldy, so we're going to keep it simple and just stick to HPAD.

Speaker 3: 11:02

Yeah, kind of like supercalifragilistic it's all it is. So we don't want to get off on a tangent with this issue. But the connection with the thyroid gland and the gonads is really not entirely irrelevant here. The number one symptom of HPAD is low energy, and the three glands of the body that control energy are the adrenals, the thyroid gland and the gonads, and all of these are controlled by that hypothalamus.

Speaker 2: 11:28

Yeah, my mentor on the subject of fatigue, which is the number one thing I saw back in my clinic, was Dr Tadabam, who wrote that great book Fatigue Fantastic. He used to say that people who had chronic fatigue had what he called quote blown a fuse in the hypothalamus, and I think it's a pretty good metaphor for what's really happening here.

Speaker 3: 11:45

We did go ahead and entitle this podcast Adrenal Fatigue. So if you're clicking back and wondering, that's true, but the people who are interested in this can search and relate to this subject on the podcast because of that titling. If you search for adrenal fatigue on Google, you'll get 26 million hits. However, if you search for HPA dysregulation, you only get a small fraction of that. So most people are still calling it and looking for it under adrenal fatigue.

Speaker 2: 12:12

Now, with all that semantic stuff out of the way, let's break it down for you so that we'll all understand what's really going on here. Let's start with what exactly is HPA axis dysfunction? Well, there's no universally accepted definition of this. It may be thought of as a failure to turn off the fight flight freeze hyper-arousal system after periods of chronic and repeated stress.

Speaker 3: 12:34

There was a great article put out from Harvard Health entitled Understanding the Stress Response, published in 2020. They explained how, quote chronic activation of the survival mechanism impairs health.

Speaker 2: 12:47

Now, what is the survival mechanism that they're talking about here? It's a complex system controlled by the brain. The number one goal of the body is to survive. Another of the brain's sentry, called the amygdala, is always scanning our environment 24-7, via our senses, constantly on the lookout for any danger.

Speaker 3: 13:04

So if the amygdala perceives danger, such as what you hear like a tiger roar, or what you see a snake in the path, or what you touch like a hot stove, or even what you think a perceived or imagined danger, for instance, then the amygdala sends a distress signal to the hypothalamus, and this is where the HPA axis jumps in.

Speaker 2: 13:25

So once that hypothalamus gets the warning signal from the amygdala, then it acts like the command and control center for the entire rest of the body, communicating and orchestrating the body's response to that perceived danger via the nervous system and the hormone system in order to coordinate the fight. Flight freeze response.

Speaker 3: 13:40

For example, if a tiger appears, and then we either need to fight the tiger, run from the tiger I'm going to be the runner, I think or freeze like a deer in the headlights which pause at this reminder of the bear under the picnic table story, Dr Mack that might be for another time, I don't know.

Speaker 2: 13:56

I'll tell that quickly. Well, I'll go and tell it right now. So years ago I was traveling through Smokies and it was kind of a cold, rainy October night, and so I decided to just get out of the rain and I went to this campsite and it was abandoned. There's nobody there, and so I slept under a picnic table in my sleeping bag and the next morning I woke to something cold and wet on my cheek of my face. I opened my eyes and it was a mama black bear sniffing me with two cubs and I thought oh no, talk about a flight response right there.

Speaker 2: 14:29

So I kind of thought well, should I fight the bear? No, I'm in a sleeping bag with no weapons. Should I flee? No, I'm in a sleeping bag under a picnic table, right. So I just froze. I just basically played possum and kind of had my eyes squinted so I can kind of keep a lookout for her. But I just lay there and played possum and she sniffed around for a while and I think I hadn't had a bath in a few days so I didn't smell too good, so she moved on.

Speaker 2: 14:54

Oh, it's so funny, but that was my personal acquaintance with the fight flight. Freeze response yes.

Speaker 3: 15:01

You know, one day, dr Mack, you're going to have to write a storybook of all your stories, all your

Speaker 2: 15:05

problems. Yeah, I've got lots of stories.

Speaker 3: 15:07

Okay, three different responses to the fight flight. Fight the bear, flee from the bear or freeze in your sleeping bag and hope he just sniffs and walks away, like with Dr Mack.

Speaker 3: 15:17

So the hypothalamus suddenly steps on the stress accelerator in order to deal with the immediate danger. And it starts by triggering its next door neighbor, the brain, specifically the pituitary gland, and this gland then sends signals, messengers, down to the adrenal glands to release the stress hormones adrenaline and cortisol. And so that's how we involve the HPA axis and it kicks in to help us cope with this stress, this danger.

Speaker 2: 15:42

And so the stress response causes many immediate physiologic changes, such as a fast heart rate, increased blood pressure, more rapid breathing, a release of blood sugar, all of which are designed to help us survive that acute danger via the fight flight freeze response. These changes can be quite helpful in the short term and actually can save our lives in the presence of real, significant danger.

Speaker 3: 16:03

But then, once the brain perceives that the danger has passed, the brain takes the foot off the accelerator and begins to put the brakes on in order to dampen the stress response, calming things down, returning the body to that resting state of homeostasis.

Speaker 2: 16:18

However, part of the issue here is that we now live in a world that our bodies were not designed for. In our fast paced world, we're faced with chronic stressors that our ancestors never had to deal with and that, quite frankly, we are really not evolved to deal with, like work deadlines, traffic jams I mean, when did the cavemen ever have to deal with the traffic jam right? Financial stress, persistent worry about losing a job, more nutrition for processed food Again the cave women didn't have processed food. Elevated toxin burden, too many stimulus like coffee and everybody's drinking these energy drinks these days, which I think the ones in the science is pretty solid on that that they can definitely be bad for you.

Speaker 2: 16:59

The chronic sickness surgery, especially repeated surgeries, drugs, alcohol, inflammation and the stress of chronic pain. We also have this 24-7 news cycle that brings us world stress. Even if you're having a good day, you're hanging out on the beach and it's a beautiful day, you can listen to the radio and talk radio and get all angry at world stress, watching depressing news on TV which is purposely designed to keep us riled up in order to improve ratings.

Speaker 3: 17:23

Yes, I think about how attached we are to just media in general, like just grabbing our phone, constantly scrolling through that feed. It's just so stimulating all that information. So, due to the modern lifestyle, many of us are also sleep deprived or out of sync with our circadian rhythms. This has a direct effect on the HPA access electric lights, screen time, shift work all culprits to our battle for getting restorative sleep. Studies have shown that folks like the Amish, without those negative influence, go to bed earlier, sleep better and they're just generally healthier. The whole factor of go to bed when the sun goes down, get up when the sun comes up it's beautiful but hard to replicate, yeah.

Speaker 2: 18:06

I know because I've worked in the ER for 20 years, mainly night shifts. I really enjoyed the ER, but I think one of the real motivating factors for me to get out of it is I knew that I was taking years off my life. I would definitely, after a night shift especially I'm working one the next day I would definitely prioritize trying to get some sleep during the day, but it's just not the same. For 20 years people said, jim, you look tired. Well, I was tired.

Speaker 4: 18:28

Right yeah.

Speaker 2: 18:31

I was just thinking and with my patients who do shift work listen, every time I drive past the hospital at night I say thank God for those nurses, doctors, orderlies, lab techs, everybody who works there.

Speaker 2: 18:44

But when my patients come in and they're having these kind of issues and they're working shift work, I always encourage them to try to find a way to get on a day shift, even if they lose that what's called shift. If that they get paid more money to work night shift, it's just not worth it for your health especially. I mean, some people are certainly more resilient than others to this, but if you're crashing and burning, it's absolutely fundamental. You got to, got to got to get a good night's sleep in, in sync with circadian rhythms. Anyway, with all this going on the chronic stress, the sleep deprivation the brain continues to perceive danger and the nervous system keeps the accelerator pedal to the metal. So the body stays revved up and on high alert. We're constantly in this fight flight, freeze mode and this is when we start to shift from a beneficial adaptive survival mechanism to HPA dysregulation, sometimes with severe negative consequences for our mind, body, spirit, health.

Speaker 3: 19:37

So now let's kind of turn in this podcast. We've got those definitions to develop this picture. Let's turn to Rachel and who's treated many of these patients. We'd love to hear from you some of your clinical observations on this subject, and maybe let's start with describing how do these folks typically present to you.

Speaker 4: 19:53

Yeah, it's interesting. I think, if I were to guess, probably 99 of the people that come in have some stage of this dysfunction, and I always explain that it's in a continuum. Some people are going to be in that first phase of dysfunction, in which cortisol is high, dhea production is still good and they're very on it. They're ro-go-go-go-go and they're just very edgy and anxious. They can't sleep but they're performing great. This fatigue hasn't settled in. A lot of these people are kind of typed a people aren't they Right?

Speaker 2: 20:27

You're right.

Speaker 4: 20:28

Right, these people have the more tendency to be like that. And then we have that people in the middle, when cortisol when I test their cortisol, so I test it using saliva, four points when they wake up an hour later for me to see the cortisol awakening response. Then in the middle of the afternoon and then at night so the second stage I see these people with very weird curves. So they'll have kind of cortisol not as high as should be in the morning, dhea production starts going down as well. And then at the end of this dysfunction I get those people that are just tired, tired completely, like their cortisol is flat lined, it's low all through the day and they just can't get out of bed. They don't have the exercise tolerance, they just don't recover, their immune system is tanked and all those things that Coach Lindsay already said.

Speaker 4: 21:16

So when they come in, obviously I'm taking the history and by the history I'm finding out how is your energy levels throughout the day? Do you wake up feeling rested? Can you go to bed? Can you stay asleep? Can you have energy throughout the day to carry on with your functions? And then this obviously will vary from person to person. Again, those type A people, they tend to burn the candle on both ends right, because they're going, going, going. They're never given themselves a chance to rest and recuperate. And these are the people that are actually trying to do everything well, even over exercising and over restricting their diet, because they think that that's a good thing. And we typically try to get these people to slow down even with the exercise and start to eat more.

Speaker 2: 21:57

Really, Rachel, I have a confession I used to think that sleep was a waste of time.

Speaker 4: 22:02

Yeah, my grandmother still thinks that I thought yeah, I thought okay, if I sleep less, I can be more productive.

Speaker 2: 22:08

Right, I have another confession. My definition of productivity has changed since I retired.

Speaker 4: 22:14

Oh yeah.

Speaker 2: 22:15

I now find that sitting on the beach is productive.

Speaker 4: 22:17

Very productive, yes.

Speaker 2: 22:20

But anyway, yeah, I mean I think we undervalue sleep right, we do.

Speaker 4: 22:25

And rest. Really, I think people kind of now understood this, the sleep thing because of detox, because of Alzheimer's, I think. People have seen this information but they don't understand the value of rest throughout the day. It's just okay, I'll sleep when it gets to the night, but I'll the morning that alarm clock hits. I am rushing and I don't take a breath, I don't sit down and eat, I'm eating on the go, and all this has tremendous impact in their health.

Speaker 2: 22:56

Yeah, you know, one thing I've been doing lately is to set my phone to go off every hour and then I go take about a five minute break and do a little exercise bike outside.

Speaker 1: 23:04

Yeah Sunshine nature exercise movement, all that stuff.

Speaker 2: 23:08

Circuit and rhythm yeah, so it's really good. But yeah, what you're describing sounds like a typical medical student. Yes, but anyway, been there, done that.

Speaker 4: 23:18

And then these people are going to describe their classic symptoms, as you mentioned above. Right, the biggest clue to me are the fatigue, the sleep issues, the exercise intolerance. They feel wiped out after exercise and sometimes they need a day or two to recover, even if they are. And then the last stage of the dysfunction. Of course, it's very frustrating for these folks. Since many of them were previously Taipei, they were able to do all these things Hard driving. Folks who like to do things like CrossFit and other forms of high intensity exercise.

Speaker 2: 23:47

I think it's really interesting because the sleep is one of the major disruptors of the HPA axis, and I found an article published in the journal Brain, behavior and Immunology Looking at the Effects of Sleep on Cortisol Levels and again, cortisol being one of the really cornerstones of this whole issue that we're talking about and they found that acute sleep deprivation significantly increased cortisol levels, but that chronic circadian malalignment significantly reduced cortisol levels, which would then create this kind of low cortisol HPAD symptom pattern that we talked about.

Speaker 3: 24:17

So to interpret that if you pull an all nighter to make it through your finals, then you'll probably have a high cortisol level for a while. But if you're chronically out of sync with circadian rhythms, like with shift workers, then you will most likely have a low cortisol level and may eventually suffer the symptoms of that like we've described.

Speaker 4: 24:36

Yes, and I have found that most of these people start having gut issues too, like bloating gas, ibs. This is because, as Dr McMahon said, the body has prioritizing survival. Digestion is not being prioritized here, so yeah yeah.

Speaker 2: 24:50

It's amazing to me how we keep on seeing that gut brain connection popping up. They call the gut our second brain. That's kind of fascinating to me. It's a wonderful book about it. I wish I remember the name. I'll put it on the website. But the stress directly affects our microbiome and our intestinal permeability and of course this then contributes to what we call blood brain barrier permeability and therefore neural inflammation, which is a direct contributor to HPA axis dysfunction.

Speaker 4: 25:17

Yeah, and these patients don't have just neuro inflammation. They often feel inflamed all over muscle, joint pain, even those fibromyalgia like symptoms. There's some weight of a chicken and the egg situation here in that chronic inflammation can contribute to the dysfunction and then the HPA axis dysfunction can also cause inflammation.

Speaker 2: 25:36

It's a vicious cycle in it. So, coach, what kind of testing would you recommend for these folks when they do come in with the history and clinical picture that Rachel discussed? And, rachel, you're welcome to chime in on that too, I think you gave a great example of that testing.

Speaker 3: 25:48

That's a live testing, four different points throughout the day. But there are other ways too to test it, and also it's important to kind of take a broad based perspective too. So usually folks with this HPA dysfunction also have like low thyroid or iron deficiency or gut problems. So we want to make sure that we're not missing any other contributing factors. As Dr Sherrill so wisely says, dogs can have ticks and fleas at the same time. So just and for listeners out there, dr Sherrill is a wonderful veterinarian.

Speaker 2: 26:20

So who happens to be my wife?

Speaker 3: 26:23

Yes. So just because they have HPA D does not mean that they also don't have a thyroid problem at the same time. In fact, these often go together and contribute even more to the fatigue. Strictly for the adrenal fatigue issue, we can check the cortisol level and the DHEA levels and we can do that with saliva tests, like Rachel mentioned. You could also do it with urine tests and then also some people do it with the first morning blood level of cortisol and DHEA. Each of those testing methods have advantages and disadvantages, which we won't go into now just because of time constraint, but your provider would be familiar with these and should be able to help you navigate. So ultimately, these labs can be really helpful in helping you know, get at that diagnosis or even understand where you are on the spectrum, like you were mentioning the different stages, rachel. Any more comments on the lab testing you'd like?

Speaker 2: 27:12

to show us.

Speaker 4: 27:14

Yeah, I always do a saliva. I do blood as well morning cortisol and DHEA and then obviously thyroid, because almost every time they're going to be having at least a problem with conversion between 2,4 and 2,3.

Speaker 2: 27:27

That's right. Because of the stress signal and because of that hypothalamus, it trickles down to both the thyroid and to the adrenals, and so they're often both affected.

Speaker 4: 27:35

And then sex hormones will be tanked too.

Speaker 2: 27:37

Right, absolutely. We see that when people have low cortisol I know for guys they have less testosterone and of course testosterone gives you energy. So I mean these people. The carnal symptom here is fatigue. That's why they call it adrenal fatigue but it affects all the glands that then give you energy. So it's really a triple whammy. Now that we've kind of talked about the pathophysiology, the history, the symptoms, the lab test, let's move on to treatment.

Speaker 2: 28:01

And my goal has always been to practice what I call unbiased, evidence-based, outcomes-oriented, honest medicine. As I said from the outset, it's a very controversial issue and I'm not taking sides here at all. To me it's 100% all about getting the patient better. So I'm going to shoot straight with you, as I always do, based on my many years of dealing with these patients, my colleagues in mainstream medicine, such as endocrinology. They do not recognize this condition at all. They go so far as to say that quote no scientific proof exists to support adrenal fatigue as a true medical condition. By the way, these are the same providers who never had not one lecture on chronic fatigue in medical school, I'm just saying. However, these patients present to me, they come to my doorstep feeling miserable, usually after seeing the primary care provider and their endocrinologist, who gaslighted them and told them that there was nothing wrong with them and that adrenal fatigue didn't exist. These patients were often desperate and they told me that I was their last stop.

Speaker 2: 29:01

On the other hand, at the under the spectrum, there are some providers who look at the world through adrenal fatigue glasses and assume that it's an epidemic, and I think, as Rachel said, I wouldn't argue that most people have some degree of it. Most people are not in stage four Just because of our lifestyle. Right, exactly, exactly, yeah, yeah. But having said that, I always try to take what are called an evidence-based approach. When it walks like a duck and cracks like a duck, then a provider has to at least have ducks on the radar screen and you need to have evidence-based plan to help these folks get better. As you know, we doctors have this model that goes first, do no harm. So I began to proceed cautiously with these folks, use my basic principles of integrative medicine, functional medicine and lifestyle medicine to put together a customized program for each of them, and over time, I found that almost all of them got better, sometimes dramatically better. Many of them would tell me that I gave them their lives back and it was amazing and wonderful for me to witness their turnaround, and it was life changing. For these patients the road to recovery was never quick, but if they and I stuck with it and we treat the program along the way as needed, then we usually saw progress. The recovery was hardly ever a straight line. These folks had their good days and bad days, but the trend was in the right direction and the goal of healthy living was attainable and was often achieved.

Speaker 2: 30:15

Unfortunately, there are a group of patients who fall through the cracks in modern medicine. These poor folks, often due to no fault of their own, are stricken with things like autoimmune disease, chronic fatigue syndrome, fibromyalgia, dysautonomia, just to name a few. And there's a common thread here with these diseases. In most cases there are no great diagnostic tests to rule out or establish a diagnosis, and to the doctor the patient looks normal. So as a provider, you either trust what the patient is telling you or you don't. Too often the medical community defaults to not believing the patient or thinking that it's just really all in their head and it's just something like a typical presentation of depression. Also, we doctors are almost universally brainwashed into a what I call a symptom pill approach to medicine, since there's no magic bullet pill for these symptoms and doctors have no solutions for these patients. And these are the patients that the doctors least like to see on their schedules. And I must admit, when I was what I call a regular doctor, before I got into integrated functional medicine, I also did not have the tools I needed to treat these patients. And, quite frankly, the modern healthcare system is just not set up for these patients. These folks have many complaints. They're complicated, they take a lot of time and for the average primary care provider, who has less than 10 minutes per patient, it's just about impossible to do these patients justice. They also require therapies that most doctors just don't know about, like nutritional counseling or herbs or supplements. And I tell these folks right up front if you have a condition that sounds like HPAD, then I highly recommend that you see an integrative functional provider. If you go to the bottom of the page one at the website magminmdcom, you'll see a link where you can go to to find a new functional medicine provider.

Speaker 2: 31:51

Over the years in the trenches of clinical medicine, I have found the subject of evidence to be very interesting and somewhat controversial. Perhaps I'll do a separate podcast on that someday. Certainly, the gold standard of evidence is a placebo-controlled, double-blind prospective study, and I get that, and I certainly turn to that kind of evidence when I can. However, for these folks who fall through the cracks of modern medicine, there usually are no such studies. The lack of evidence, though, doesn't give anybody the license to take advantage of these desperate folks and to apply any kind of quack therapies which makes the doctor richer and breaks the patient's piggy bank. However, after seeing hundreds of these kinds of folks, including those with HPAD, and using the basic tools of functional, integrative and lifestyle medicine, over time I built my own body of evidence Before my eyes. I consistently saw these folks getting better and, to the best of my recollection, I don't recall any patients who were harmed by the program. So the bottom line was that it worked for my patients, the very patients who were unable to find help elsewhere.

Speaker 3: 32:50

I love that story that you have, Dr Winkman. All those people that have been able to be touched by that.

Speaker 2: 32:55

Yeah, that's right.

Speaker 3: 32:56

You know, another factor is that traditional medicine only looks at the extremes of adrenal dysfunction, which would be like Addison's disease, where we have almost zero cortisol, and then Cushing's syndrome where we have way too much. They don't tend to take into consideration those patients who are on the low end of the spectrum of cortisol but don't quite qualify by number for Addison's disease. So these people can be quite symptomatic, but they tend to be told that there's nothing wrong. They look normal and their cortisol levels are normal because they fall in those parameters, those hard numbers.

Speaker 2: 33:32

Right and now. Lindsay, you had a situation with your beloved husband where he had one of these kind of diseases and he was also kind of gaslighted and dismissed.

Speaker 3: 33:41

Right.

Speaker 2: 33:42

Yeah, tell us just a bit about that.

Speaker 3: 33:44

Yeah, you know, tyler got really sick a couple years ago and we just could not figure it out. We went and saw all the different types of specialists cardiology, neurology, gastroenterology, we saw them all and everyone really didn't have a solution. They just said you're stressed, you're depressed, you're anxious, he was having fatigue, he lost 30 pounds in a month. He couldn't get off the couch without veining. We just didn't have viable solutions for true symptoms that he was experiencing. So thank goodness for Dr Mack he's one of your stories really and we're really grateful for that. It took some time to kind of peel back the layers and uncover that it was dysautonomia and we actually got to do a podcast on that, which was awesome.

Speaker 2: 34:28

I forget which one it was, but you can look at the list and find out. I don't know the number, but yeah, it's in there Now. He also went out to see Dr Nemecek out.

Speaker 3: 34:35

Yeah, yeah, out in Arizona he helped him a great deal with autonomic dysfunction. It takes a village right. Yes, yes.

Speaker 2: 34:42

So it's always interesting to me that if you have a morning cortisol of maybe 2.9, then you need to cryotere for Addison's disease, but if it's 3.0, you don't and there's nothing wrong with you. It seems like we do that a lot in medicine. We draw these lines in the sand and if you're like 0.1 below the line, you have the disease and you get treated. If 0.1 above the line, you don't, and here's your Prozac. So just to let you know that I'm not shooting from the hip and that stress-induced low cortisol is real. Let's take a look at some of the published scientific evidence for HPAD from the mainstream peer-reviewed medical literature. In a 2012 study, they found lower cortisol levels in the presence of PTSD, especially in women, which points out that the HPAD can be somewhat sex-biased.

Speaker 3: 35:22

A study from the Journal of Clinical Medicine demonstrated that women with postpartum depression had significantly lower cortisol levels than women without postpartum depression, suggesting that HPA access to dysregulation in these women, and I think honestly that information would help these women not feel so bad about being a failure as a mom If we started using some of this medical terminology. I have so many friends, Dr Mack, I'm in this stage of life I have so many friends that are dealing with postpartum depression and I work with that population of patients now and I just think about if we used these terms, how would treatment change?

Speaker 2: 36:01

Absolutely so. A study in the International Journal of Bipolar Disorders demonstrated that patients with bipolar disorder tended to have lower cortisol levels.

Speaker 3: 36:10

A number of studies have shown that patients with significant adverse childhood events, especially ones with inadequate care or neglect situations during critical periods, alter the HPA access biology and, as a result, those individuals have lower than expected cortisol levels. Other studies suggest that there might also be even a genetic component to this, that's interesting.

Speaker 2: 36:32

In a study published in the journal Psychoneuro Endocrinology that's a mouthful in 2019, they found a higher life trauma exposure was significantly associated with lower basal cortisol levels.

Speaker 3: 36:45

Here's another one. An article published in the prestigious journal Endocrinology in 2011 stated quote several stress-associated neuro-psychiatric disorders, notably post-traumatic stress disorder, chronic pain and fatigue syndromes, exhibit low plasma levels of the stress hormone cortisol. The effects appear greatest in those initially traumatized in early life, implying a degree of developmental programming.

Speaker 2: 37:10

Now, that's interesting, coach. So here we have an article from the journal Endocrinology which states that people with fatigue have lower cortisol levels, and yet the Endocrin society says that adrenal fatigue does not exist. Go figure, coach. And finally, from the journal Self, they found that people with long COVID with respiratory symptoms tended to have low cortisol levels. Isn't that interesting? That's very interesting.

Speaker 3: 37:36

So again, we present this science to you listeners, to demonstrate that the HPA dysregulation is real, it's not just in your head and it can be treated. That's the beautiful thing. Even though mainstream medicine doesn't recognize adrenal fatigue, we have demonstrated, via this review of peer-reviewed scientific literature, that there are many stress-related conditions that are associated with low cortisol levels.

Speaker 2: 38:00

So, now that we've outlined some of the science which validates HPAD and we have talked about the history and symptoms of these patients, let's move on to treatment. So, rachel, please get us started with some of your suggestions on a treatment regimen for these folks.

Speaker 4: 38:14

Yes, absolutely. So obviously it's going to vary where this patient is in that continuum.

Speaker 4: 38:19

So if those people have a very high cortisol. That's how it starts, right, I need to help them get that down. If they're in the middle, I need to modulate that. If they're really low, I need to help them bring that up. But it always, always starts with stress management. I can't tell you how many times I have to actually explain to people what stress management is. They really don't understand.

Speaker 4: 38:42

If we're always in that traffic, work, stress, family stress we cannot get rid of that. We can't quit your job, in most cases, right, you can't not be in traffic. You can't get rid of kids. Exactly, you have to tell your body that you're OK, a couple times a day, activating the opposite from fight or flight, which is the parasympathetic nervous system. And there's many scientifically validated methods for that meditation, breath, work, tapping, chanting, humming cold water on your face there are many things. And I just give the patient the list and say, hey, pick one, two, three that you like and start there and you have to do it. It's your homework and usually the person that comes in the office. They don't want to hear that. They want a supplement, right, they want to give me something to take.

Speaker 2: 39:28

Or if they go to the doctor, they want a pill or that's one of the real problems with modern medicine is doctors and patients have become brainwashed and thinking there's a pill for every pill. And we don't need to do the hard work of eating right or getting exercise or reducing stress.

Speaker 3: 39:43

Right, and what you're talking about is truly a functional approach. What's the root cause of this is the stress associated lifestyle, so we have to mitigate that by hitting the pause button.

Speaker 4: 39:55

Right, yeah, so it was the chronic stress that probably got them into the difficult place in the first place. So they're never going to get completely over it if they don't reduce their stress and learn to cope with their chronic stress better.

Speaker 3: 40:08

Can't supplement their way out of that one.

Speaker 4: 40:10

You cannot, nope.

Speaker 2: 40:11

Mm-hmm. Yeah, yeah, I actually encourage these people to take a piece of paper and write down. Here are my stressors.

Speaker 4: 40:17

Yeah, Some of you can get rid of right.

Speaker 2: 40:18

So you go through the list and say here's the one I can get rid of, but then you're always left with a bunch of stuff you can get rid of right. And so then you've got to learn, as you said, to cope better and to actively do those things like the breathing techniques or the meditation or time outside in nature or whatever that bring you joy and things that activate that parasympathetic system. Right, yeah.

Speaker 4: 40:39

I just want to make a little observation here. Usually, when I talk about stress management, the one thing that they tell me they do, but I exercise. Right Well vigorous exercise, which is usually what these people are doing running, jumping, crossfit, rebounder, things like that. They're great for you, don't get me wrong. Please do those, but they're not stress management.

Speaker 4: 40:57

They're actually making your body secrete even more cortisol and adrenaline during that phase. Yeah so yoga, depending on the yoga, if it's power or hot yoga. It's also not stress management, but depending on if it's like a more gentle yoga and a Pilates, and there are types of walks in nature are amazing Walk through the woods exactly.

Speaker 2: 41:16

Yeah, isn't that?

Speaker 4: 41:16

Amazing. I mean they've done studies that it reduces blood pressure by, like I don't know, three points, four or five points. It's crazy to walk in nature.

Speaker 2: 41:24

So it's great Listening to birds. Chirp reduces your cortisol levels. Yeah, you like birds?

Speaker 4: 41:28

don't you? You do bird watching. I love that. I mean, we lost that connection. It shouldn't surprise us. We lost connection with nature with its cycles with its beauty.

Speaker 2: 41:39

Yeah, yeah, so just that little caveat.

Speaker 4: 41:42

If you think that you're exercising managing your stress depending on what exercise you're doing, it's not exactly great.

Speaker 3: 41:48

I think that hits on to this mindset that we have as a culture of just being macho and how we just value. It's going to push, say, in the work environment, people that are working four or five days in a row. The atmosphere is like, oh, you're doing so good, that's so great. You're working so hard, or you're exercising, you're doing awesome, but there's not really a hey, you're doing so great that you've built in yoga and deep breathing into your lifestyle. It's like if you're out there dying on the line, good job, keep it up.

Speaker 2: 42:18

Yeah Well, most people work five days in a row, right, Right, yes, I'm sorry, I work as a nurse, so 12-hour shifts is what I'm referencing.

Speaker 3: 42:26

So people working 12-hour shifts in a row, five days in a row it's pretty insane.

Speaker 2: 42:30

Yeah, anyway, well, we did an entire podcast on stress and you can go back and listen to that. It's number 11. I think it's pretty good. So I also have a couple of excellent documents on the website called the McMinn Stress Plan and the McMinn Stress Toolbox and those kind of go together and you can find them at McMinnMDcom slash documents. So since we've already addressed that issue on the previous podcast, then for time's sake we won't reiterate the stress approach today in great detail. So, coach Lindsay, now that we've dealt with stress, what else would you advise these folks to do as far as lifestyle modifications to address HPOD?

Speaker 3: 43:05

Probably the most important thing that you can do for these people is to place a high priority on getting restorative sleep, and this needs to be in sync with circadian rhythms, like you were saying, rachel.

Speaker 3: 43:16

It doesn't work to sleep all day and be up all night, even if you get the eight hours. It's not necessarily about the quantity, it's the quality and when it's happening. Sleep can really be a challenge for these patients and for the provider too, since they often have the days and nights mixed up pretty seriously. We typically start with sleep hygiene, so that includes things like blue light blockers and then perhaps some supplements melatonin or valerian, for example but the motto at the clinic is whatever it takes, right, dr Mack. So we have an excellent document for you on the website about sleep hygiene and getting a good night's sleep. We also have a summary document called McMinn Sleep Therapeutic Options for you, so you can find those on the website McMinnMDcom. Forward slash documents and I highly encourage you to check those out. Bottom line make sleep a priority and work with your provider to make it happen.

Speaker 2: 44:12

And so, Ms Rachel, what other lifestyle changes would you recommend for these folks?

Speaker 4: 44:16

Yes, there are many lifestyle changes. Grounding is a super powerful one. That would be something that you would walk barefoot in any kind of natural soil. So sand, dirt, grass, even concrete. I learned that can help as well to kind of calm your system. Turn on that parasympathetic.

Speaker 2: 44:34

Now, before we move off, grounding aren't there like grounding sheets and grounding mattresses?

Speaker 4: 44:38

I have grounding pads at home and the PMF mat, which is quite pricey. But you can buy just grounding mats, earthcom or earthing. I think it's earthingcom right.

Speaker 3: 44:49

Yeah, I can even find them on Amazon now.

Speaker 2: 44:50

Yeah, I had some grounding sheets one time and I didn't feel a difference, although I think sometimes things go on that we can't necessarily feel it may have been doing some benefit for me, but I didn't feel a difference.

Speaker 4: 45:02

You also don't feel the Bluetooth harming you. Here we go.

Speaker 2: 45:05

Exactly, a lot of things are good for you. I mean, I don't feel better when I eat spinach, but I know it's good for me, right.

Speaker 1: 45:09

Correct.

Speaker 4: 45:11

Anyway. So what else? Definitely, I talk a lot about the over-exercising piece, especially for the women. They, because of this adrenal dysregulation that affects their sex hormones and their thyroid, they start gaining weight, especially around the midsection. They go crazy and they start exercising more to compensate and that worsens the problem. So we really have to have a heart to heart on that. Fasting is another thing that they're doing to prevent the weight gain, but it backfires because it's worsening the condition. I talk to them about time and nature, fresh air, sunshine, everything that's related to the circadian rhythm regulation. Our rhythms have to go according to what the earth is doing right. If the sun is, we try to be up. If the sun is down, we try to wind down. Laughter, watch comedy, not action thriller, especially at night, not to get you all riled up before sleep, avoiding those tough discussions with anybody at home.

Speaker 2: 46:08

We watched one of the old Steve Martin movies that night. Oh my gosh, a lot of great belly laughs yeah.

Speaker 4: 46:14

Just makes you feel lighter, doesn't it?

Speaker 2: 46:15

Yeah, sure.

Speaker 4: 46:16

And then obviously doing exercise non-competitive because of that cortisol piece. A short nap during the day could work for some people that.

Speaker 2: 46:25

Let me come on down to non-competitive exercise. So I used to be a tennis player for like 40 years. I loved it. But I think exercise is a good thing, but sometimes when I would lose a match I thought I should one, I was pissed off for days.

Speaker 4: 46:37

Yes.

Speaker 2: 46:38

Yeah, I'm just saying.

Speaker 4: 46:40

The under personality.

Speaker 2: 46:41

Right, right, I think that exercise is great and I'm off work, but when people have this condition, they should definitely do non-competitive type stuff.

Speaker 4: 46:48

Correct, right composition is so important. These people have to be. It tend to be very dehydrated and the reason is where, anatomically, where your adrenals are is on top of your kidneys, it affects affects the fluid balance in your body. So when you are stressed you pee out a ton of your minerals and so that's why you have that Orthostatic hypotension. When you're sitting down or laying down and you stand up, that's one of my signs for myself. When I start standing up and feeling dizzy, I'm like oh, oh, my stress is out of hand and I have to dial down and hydrate a little more. So hydration is super important.

Speaker 4: 47:24

Intimacy, just having that time to connect with your partner, your children, your friends. If you don't have a partner, try not to listen to talk radio or obsessively watching the news and, you know, using positive affirmations, everything to turn on the parasympathetic nervous system and take you out of that fight or flight. Developing affirmations, mantras, like every day and every way I'm getting better and better, and then, when you have a negative thought, try to substitute it by your mantra and go back to your breath, and breath work is so Important. People have shallow breathing, they're only breathing with their necks and chest and the blood and the breath is never coming back to their Into their belly, like a baby. If you watch a belly, a baby breathe. Their belly is going up exactly. No, then we have to identify the energy robbers and try to, like dr McMinn said, make a list of your stressors and the ones that you can avoid, please do, and Careful with those negative people you know, sometimes you have to put that boundary.

Speaker 4: 48:23

Obviously there's bosses, for example. You can't really put a boundary around, but there are people that you can and you should.

Speaker 2: 48:30

You know, learning to say no sometimes can be helpful as well. Right? Just a quick mention of salt. You talked about how these people lose minerals. I think a lot of times that they lose a lot of sodium, and that contributes to this lightheaded feeling. So every now and then it might be helpful to get a little bit more salt via salt in your food, or Sometimes, when these people are more severe, I have them do like a little salt water drink in the morning or even use a salt brine. Yeah, yeah, and I actually have a recipe for salt brine.

Speaker 2: 48:58

Which I can put on the website for, so it'll be in the documents section.

Speaker 3: 49:01

What kind of salt do you guys like to use?

Speaker 2: 49:04

I defer to Rachel.

Speaker 4: 49:04

I use a him and see salt, but yeah, anything that is from in nature, the way it came from nature. So I use Malden salt, redmond's real salt, which is pink. They're either from salt caves or from the ocean, right, and these salts do not only have sodium chloride. Table salt, iodized salt, will Regular, iodized or not, table salt will just have sodium chloride. There's a two minerals, but there's only two, and these other salts you're gonna have 50 plus in very minute quantities, but they're so much richer in minerals than just Regular table salt.

Speaker 4: 49:40

So you pay a little bit more, but it's really not that much and it's really worth it to have a high quality salt.

Speaker 3: 49:46

That's great and you know a lot of those lifestyle things you're talking about. I was just reflecting, as you're going through them, that it it truly is an effort to build those in. You know, it's not just like, okay, today we fit all those in, I'm good for a month. You know, it's really the small everyday things that chip away at that. If we're consistent with it.

Speaker 2: 50:10

Yeah, and as we said in the podcast a couple times ago, that lifestyle medicine is the most powerful medicine on earth. What's gonna? We defaulted to the symptom pill thing, but that's just not not the solution here, right? You gotta gotta gotta get back to lifestyle and that's what's gonna reduce your stress, which is isn't what's gonna ultimately heal you from this.

Speaker 2: 50:29

Um but, speaking of breath work, we do have a document on belly breathing. You can find at McMint NB comm dash documents lots of resources for you there. We're working on the website, trying to get it better and better and get more and more resources for you, and we recently did a podcast once gonna lifestyle medicine and that's number 34. If you want to learn more about that. It's a very applicable to this problem.

Speaker 3: 50:49

You know, one day, years down the road from now, someone will be smart enough and be able to get it to work. Where we teach children in schools? Absolutely yes, at an early age, and then we model it at home and we do it right for them.

Speaker 3: 51:03

We live it actively. You know I think about sometimes we try to like okay. So I think so much as a parent right now because I have a two and a four year old at home. But I just think about how I handle conflict in our house. You know, tyler and I don't always agree shocker, but how do I handle that? You know, I don't want to hide that away from my children. I want them to see what it looks like to have disagreements in a healthy way.

Speaker 3: 51:27

Mm-hmm and you know, I think the same thing here. You know how can we live out and how can we work through, actively, work through. It takes time to figure out how to stress, manage like it's not perfect the first day you start doing. It's not perfect the first day you try to meditate. It even feels fake, doesn't it?

Speaker 3: 51:41

sometimes yeah, yes, and so we have to model for even ourselves, like it's okay to practice, it's okay to fail, and I have to work at this Actively, to have this as a lifestyle and just think about what will our next generations. I think they will outsmart that, I think I think we'll find a path forward, but yes, you know there's so much good science on meditation.

Speaker 2: 52:02

Dr Herbert Benson at a Harvard wrote this great book called the relaxation response. I don't know if you'll read that or not, but it's really good and he in a very scientific way shows how it it has all these amazing benefits to the body, and I think that's been replicated over and over and over in other studies. I remember back up in Boston I took a course on meditation and it just didn't work for me. I couldn't, couldn't stay there. But you know what I've learned? Is there different kind of meditations?

Speaker 2: 52:26

Absolutely I've turned to things like Kirtan meditation or a loving kindness. Love, kindness meditation and guided meditations are really wonderful because you know you might not be able to sort of stay in that quiet place yourself, but if you have somebody talking to you in this calm voice and kind of coaching you to stay there, then it's really helpful. So I think that if you can't do this sort of the classic mindfulness meditation, then you can maybe kind of try different kinds of meditation and eventually it'll get you there. Certainly the other things like yoga are Are the helpful, but I think the thing this has the most direct impact on that calming effect in your brain is meditation.

Speaker 4: 53:05

And yeah, I would say that in breath work, yeah, yeah, which is a form of meditation. Well, you meditate. Why do you breath work? Yeah, yeah, yeah.

Speaker 2: 53:12

So yeah, so anyway, so check that out, yeah.

Speaker 3: 53:15

But also there's things like so, to kind of jump in back Other things that we have to address when we're talking about this. Apart from lifestyle medicine, things like toxins, mold, food allergies those also place stress on our bodies and our brains and can contribute to this HP AD dysfunction, so just keep in mind that. If, though, that might also apply to you. So we did an excellent podcast on toxins, which, if you haven't heard, check that out it's number 22. We haven't done when yet on mold it'll be coming out, but, however, if these issues might apply to you, then please plan just to discuss this with your provider and address those issues of Toxins, mold and food allergies and, as Rachel was saying earlier, gut health is also linked to HP AD.

Speaker 2: 54:00

We did a whole gut health series, so let's go back to podcast number three through seven to learn more about that. And I have said many times, if there is a gut everything connection, certainly gut stress connection, gut brain connection, which leads to a gut adrenal connection. So now, rachel, please educate us more about the rule of nutritional support in these folks.

Speaker 4: 54:18

Absolutely. It's so important. Body that is undernourished is under stress. If you're eating an inflammatory diet full filled with processed foods and additives that irritate your body, you're going to be under stress. So we need to do a whole foods diet balance diet. The most Difficult thing for me is to actually to get these people to have breakfast. They are waking up in a rush, they're leaving out the door and, if anything, they're grabbing something super high in carbohydrates, right, and that will cause a big spike and then a big dip in there and their blood sugar, and when that happens, that triggers a stress response as well. So getting protein as soon as you wake up whether it's animal protein or vegetable protein, it doesn't matter but get enough protein for breakfast is huge.

Speaker 3: 55:05

What are your favorite breakfasts to recommend to people that are savory a?

Speaker 4: 55:10

baby people would, was it Savory what is the same as a very breakfast. So that would be eggs. That would be a breakfast taco with ground meat or pulled chicken, or a breakfast sausage that is clean, right, with good cream, clean ingredients. Do you have your recommendations for brands of sausage? Absolutely. Applegate has just turkey and seasoning Butterball is not organic and it's cheap, but it's also just turkey and seasoning rosemary and some salt. I think okay, yeah, yeah, it's really cheap. What's read your ingredients, guys? What's the problem?

Speaker 2: 55:45

I what's nutrition? Changing all the time and I think most of us are really confused. So we're so happy to have you here, but what's the scoop on oatmeal? I mean, that used to be thought of as a healthy breakfast, but now we have all these people coming out. Dr Gunn read, you know all the right in the bashing oatmeal. So what's the latest scoop on oatmeal from a nutritional point of view?

Speaker 4: 56:05

So the lectins, I can't really tell you because it is very individual. Some people will react to lectin, some will not, and the only way to know is doing an elimination diet, removing all lectin containing foods and putting it back in and seeing If your joint pain, if your muscle pain, if your fatigue comes back. That is a little bit more hard to navigate. The lectin's part. But what I can tell you about oatmeal if you're not preparing it and I see this a lot oatmeal is easy. People are doing it and thinking that they're having good fiber, and it is good fiber, guys.

Speaker 4: 56:33

But it's also very carbohydrate, drate, heavy, and I have worn a continuous glucose monitor before and I saw it in practice how my blood sugar will spike with oatmeal and Not spike if I have eggs with it or if I put collagen powder, protein powder, in it with this. Okay. So it's hard to achieve Stable blood sugar with a sweet breakfast cereal, oatmeal, toast and jam, things that are muffins. It's much more. It's much easier to find that balance in your blood sugar which is so important for your stress response with a savory breakfast. That being said, you can have an oatmeal with protein powder in it and not have that much of a glycemic response.

Speaker 4: 57:15

So just oatmeal with fruit, you're adding carb with the carb and that's what people are doing Cook their oatmeal and water and put fruit in it. So you're just having a lot a big carb load and carbs are great. Do not cut your carbs, but Exactly, they need to have those carbs. But you have to pair them with your proteins and your fats so that you're not having those spikes and dips. Spikes and dips all that triggers Adrenaline and cortisol. Right, because if you're really high and then you're really low, that's stressful. It is stressful on the body, correct?

Speaker 2: 57:47

I'm sorry I interrupted you on that, so please continue with your talk about nutrition, absolutely.

Speaker 4: 57:51

So replenishing minerals, like we said, sodium. People are very scared of salt and yes, there is a small percentage of the population that genetically are salt sensitive and you can actually get that tested. But For most people it's okay to have a little bit of salt not in processed food, a real good quality salt in your food. And Sometimes people do need extra and you'll know you'll get lightheaded and you know feinty and things like that. Adequate carbohydrates let's not restrict all those carbohydrates, ladies, even if you're trying to lose the weight. So keto diets, very low carb. This is very stressful for the woman, especially women, and we need carbohydrates to correct, to make progesterone, to make our Receptors sensitive to our thyroid hormone. So if we're restricting carbohydrates all the time, your metabolism is wonky.

Speaker 2: 58:42

Very complex carbs and not simple carbs, right yeah correct complex carbs.

Speaker 4: 58:46

So from your grains, your roots, your fruits, the veggies, and Try not to fast over 12 hours. Some people might eat, might even need a little bit more frequent eating if they're having those episodes of low, low, low, low blood sugar. What's happening usually with people waking up between 2 and 4 am Is Usually two things either you're having a dip of your blood glucose and then your body responds with cortisol that wakes you up, or it's not the blood sugar piece, it is just the cortisol piece. So wearing a continuous glucose monitor really helps me navigate that.

Speaker 3: 59:17

I think that's really interesting technology. I can't wait to let. Yes available more broadly somebody that they?

Speaker 2: 59:24

I was asking them. They were concerned about their blood sugar. I asked them if they wore a monitor and they said no, I can't afford it. Yeah, how can you? Is there any way? You can at least try that out for a week or two Inexpensively no, unless you have a prescription for it.

Speaker 4: 59:41

If you can get a prescription for it which you would have to be probably, I guess, diabetic, not even pre-diabetic, right, yeah, you'd have to make criteria to get the prescription, wouldn't you?

Speaker 3: 59:48

Yeah, I think it's coming, it is coming, it is coming. Many companies are coming out very.

Speaker 4: 59:52

As far as I know, is the cheapest one, but still really expensive. Yeah okay, try not to skip meals, because Starvation the body doesn't understand. You're just going to have a meal later right the body just feels I have blood low blood sugar, there's an emergency, so try not to skip meals, especially breakfast eating. A breakfast with protein is part of circadian rhythm regulations. Obviously, sunlight exposure and darkness at night is the most important piece, but breakfast with protein is huge for that and how much protein.

Speaker 4: 1:00:26

I would say shoot for a minimum of 25 grams. Okay, yeah, it's going to vary according to your size, so that's a little math that we do, but I would say minimum for everybody. If you're not a kid, obviously minimum 25 that's a good number to know yeah, okay, and then never having caffeine on an empty stomach. This is.

Speaker 4: 1:00:45

Huge people do not understand how stressful it is on your adrenals for you to have caffeine on the on your on an empty stomach. It increases our cortisol secretion. So the morning is the part of the day that your adrenals are working the hardest because it's supposed to wake you up with higher cortisol in the morning. And if you're making it stress even more at that phase on an empty stomach which is we already talked about how fasting and being on an empty stomach is stressful you're adding two stresses at once at the most stressful part of the day for your adrenals. So also having caffeine in the morning can interfere with your sleep. So caffeine has a very long half-life. We would say average eight hours, but it really really depends on your genetics. It can go up to like 12 hours half-life. That means in 50% of it is still in your bloodstream after that amount of time.

Speaker 4: 1:01:39

So if you have trouble sleeping, which a lot of these people do. If you wanna have your coffee, I say have a half-caffeine the morning and that's it, if you can quit or wean yourself off of caffeine while you're in treatment. And let me remind you that treating adrenal dysfunction is not a quick fix, because it took you many years to get there, so you're not gonna fix it in a month.

Speaker 2: 1:02:00

All right, well, thanks so much, rachel. It's very interesting. Yes, now, please also now tell us about the role of supplements in HPAD.

Speaker 4: 1:02:09

So vitamin D is one that we can use. It binds to the binding to the vitamin D receptors in the hypothalamus and the pituitary will help regulate the secretion of those hormones that are involved in your HPA axis balance. It's also an anti-inflammatory. So these people, when they're inflamed, when our bodies are inflamed, whether it's from toxins, whether it's from a bad diet, parasites, whatever it is, infections, it puts a strain on your body. So it reduces chronic low-grade inflammation that is associated with the HPA axis D, so it helps normalize the situation. Omega-3 reduces inflammation in the brain and these people remember right at the beginning of the podcast we were talking about how these people have neuro inflammation. So this can help also regulate some neurotransmitters, which are the little messengers in your brain. Helping you decrease your stress response enhances your cell membranes, how they communicate with each other, so it helps in stress regulation that way.

Speaker 4: 1:03:05

Magnesium is huge. I use magnesium all the time and some of these people actually they have such poor mineral status that if I actually give them a magnesium pill they'll feel worse. So I have to replenish potassium and sodium first before I start magnesium, which I what I do is I give them transdermal magnesium. So either on a foot soak or a bath or oil, just like with their body lotion. It absorbs super easy, fast and it doesn't give them that crash that maybe an oral magnesium might give them Vitamin C huge.

Speaker 4: 1:03:38

The adrenal glands are the organ in the body that use the most vitamin C in the whole body and it gets very depleted in this in these dysfunctions. So I always use food-sourced vitamin C. So either we're using actual citric food fruits, kiwi, but I usually like to use it as a supplement acerola powder or camu camu, which is super, super rich in vitamin C and the flavonoids that come with it. Every time we take a nutrient and we isolate it from the food and make it into a pill, we don't get the benefits right. We wanna use the whole food matrix, how God packaged it nicely that your body can use it. I love how you said that. And then mitochondrial support. There's many things that we can do for mitochondrial support, like alfalfa-pocacid, carnitine, also magnesium and vitamin C D-ribose, because the mitochondria are the little powerhouses of the cell that are producing battery for you to keep going.

Speaker 2: 1:04:35

Well, wonderful. Thank you so much, Gosh. I could just sit and listen to you all day, you know, I think your brain is so bright with all that kind of stuff, but I do find the adaptogens to be very interesting in the setting. Coach Lindsay, tell us more about the adaptogens and how they might be helpful here.

Speaker 3: 1:04:49

Right. So adaptogens are defined as a natural substance that can help the body adapt to stress and to exert a kind of a normalizing effect upon bodily processes. So another way of saying that, or specifically in the case of HPAD, if your cortisol is high, an adaptogen such as ashwagandha can help bring it down, modulate it down, and if it's low, then an adaptogen could alternatively help bring it back up to normal range. So it's a nice little modulator, a balancer.

Speaker 2: 1:05:19

And so, rachel, what are some of the specific herbs or adaptogens that you recommend for HPAD?

Speaker 4: 1:05:25

That's going to depend on where the person is in that spectrum. So if they have very high cortisol I want to bring it down and then if they have very low I want to bring it up. So it will depend. Usually I'll use cordyceps for those people that have very low cortisol and then some modulators, like holy basil, like a Tulsi. It helps modulate. So if the person has the wonky cortisol, I say in the middle there they're not very high and they're not super low I like to use Tulsi, like that ashwagandha. Like you said, there are several mushrooms and herbs are great for these.

Speaker 2: 1:05:59

Yeah, one of the treatment I found to be quite helpful for these patients was the use of hydrocortisone. Most of these people are sick and tired of feeling sick and tired and they all wanted to start feeling better sooner than later. Of all the treatments I used on these folks, a physiologic dose of cortisol seemed to get them feeling better the quickest. And, by the way, cortisol, cortef and hydrocortisone are all just different names for the same thing. Cortef is just a trade name for cortisol. So again, one of the main issues here is low cortisol. So, as an example, if you're low on potassium, you eat a banana or you take potassium. If you're low on magnesium, then you take magnesium. So here you are low on cortisol, so you take cortisol. It's the exact same cortisol that your body already makes every single day. There's an excellent book about this called the Safe Uses the Cortisol by Dr William Jeffries, and I'll have that on the webpage for you. You can find it at mngmndcomcom references. The key to this treatment is to use what I call physiologic doses, not pharmacologic doses. If you take too much cortisol, this can shut down your body's own production, and this is called adrenal suppression. So your own body should produce somewhere between 20 and 40 milligrams of cortisol every single day. So if you start low, you usually start with maybe the five milligrams and you work your way up and eventually end up around maybe five to 15 milligrams. You will not get the adrenal suppression and these patients will often see immediate benefits with improved energy, less brain fog, less weakness, better immune function and less inflammation, et cetera. So here's what I did with these patients. I would typically, as Rachel was talking about, take a good history, check their levels, and their levels were low and the symptoms matched and they had lots of stress before this all began and it all added up once when we talked about, you know, walking like a duck and quacking like a duck, then these tips were usually the things that led me to try around a cortisol. It's really a no-lose situation because if I'm right and they do need it, then they get immediate relief, and if they don't need it, then their own body just makes a little bit less of it via the feedback loop. You just can't hurt anything by doing this and yet you'll probably help and the right patient is definitely worth a try. Now I won't name names here, but two of the best experts I know of in this field go so far as to say that any patient with chronic unexplained fatigue deserves a trial on a low physiologic dose of cortisol, and after many years of treating of fatigue patients, I would not disagree with that assessment.

Speaker 2: 1:08:17

I do want to emphasize the point that this is a very natural therapy. When you take cortisol, you are taking the exact same thing that your body already makes. Just because it comes in a pill form and you get it from the pharmacy doesn't mean that it's not natural to your body. You can also buy potassium in pills that come from the pharmacy or magnesium pills that come from the pharmacy, and they're still natural to you. I do agree with Rachel. If you can get things in a whole food form, that's always better. But we're talking about a significant illness here and we want to get these patients better quicker so we can use the isolated hydrochlorosome In the end stage of a chronic stress situation. You're not making enough cortisol, so supplementing is just an attempt to get you back to a normal level. We're not getting you high, just getting back to a normal level where you feel better and you're healthier.

Speaker 3: 1:09:01

And then, once you get to feeling better because you have also attended the fundamentals, like we've been discussing stress reduction, restorative sleep, improved nutrition, targeted supplements and lifestyle changes then you can slowly wean off the core test.

Speaker 2: 1:09:15

And just a word of caution here prescription cortisol management should always be done in the cooperation with a medical provider who is knowledgeable about these core tests. Again, it done properly is very safe, but there are a few tricks of the trade that your provider will need to know about. I've used this therapy on many patients over the years. I found it to be very helpful and I even took it myself for quite a while, and over those years I have used this and prescribed it. I've never had a single patient who had any trouble with it.

Speaker 4: 1:09:43

So you can also use some adrenocortical extract, which is a glandular. It comes from an animal, so I guess for vegans that would be a problem, but it's over the counter and while Cortef is by prescription only. However, if you do take the adrenal cortisol extract you, then I recommended that you talk to your provider, so you're not doing two things that are acting in the same way and can be too much.

Speaker 2: 1:10:09

Now. In the McMinn clinic, over the years, we used adrenal cortical extract and we found it to be effective for some patients. However, for the more severe patients, we found the Cortef to be more effective and more manageable. It's also a bit cheaper, since it tends to come in a generic form and it may be covered by insurance. One more word on this issue Do not substitute other steroids, such as prednisone, for cortisol. Cortisol is bio-identical, just like yours, whereas prednisone is not, and these other steroids typically have more potential for greater downside effect profile.

Speaker 3: 1:10:39

So, as we wrap up this podcast, I think it's worth mentioning that we have a diagram that you might find interesting, which illustrates the effects of stress on the body. Remember, how we mentioned earlier, cortisol receptors are all throughout the body. It can affect the entire body. So check out this document it's on McMinnMDcom forward slash documents and you'll be really amazed. And more than amazed, I think. You'll be motivated by seeing the wide spread effects of stress on our bodies, just motivated to move forward and start adopting some of these things we've been talking about.

Speaker 2: 1:11:10

Also a couple of great books on the matter that you might want to check out, and both of them are written for the lay public. One of the books on the subject is called Adrenal Fatigue the 21st Century Stress Syndrome by Dr James Wilson. The other book I like is called Feeling Fat, Fuzzy and Frazled by-.

Speaker 3: 1:11:25

Certainly catchy.

Speaker 2: 1:11:27

By Richard James MD, and you can find the titles of both these books at McMinnMDcom slash references. And now let's share some final thoughts. My take home message is that HPAD is a very real condition, I think, as we have shown you from the scientific literature we reviewed which supports it. Unfortunately, it's been called by a confusing and misleading, inaccurate name, creating a lot of controversy. The good news is it can be successfully treated.

Speaker 2: 1:11:53

We have witnessed this many times over the years with our own eyes. So consider the symptoms we talked about above and, if it fits you then find a provider who can work with you and get you on the path to recovery. I'll also place a document for you at McMinnMDcom slash documents with a list of symptoms of HPAD so you can check that out and compare them to your symptoms, and check out the links section on page one of McMinnMDcom for information about how to find a functional medicine provider, or contact my friend and colleague, ms Rachel, right here. So she's treated this many times over the years and so you might want to just give her a call.

Speaker 3: 1:12:28

That sounds great and, Rachel, anything else you want to share on the podcast before we wrap it up today? I even wanted to ask you have you personally had experience to adrenal fatigue and what does that? Look like Absolutely Is that made you passionate about this topic.

Speaker 4: 1:12:42

Yes, so grad school did it for me. I don't remember being as anxious as I was right after ever in my life, right after grad school. And I am a type A, you know go, go, go, perform, perform, never stop exercising Although I'd never ignored the nutrition piece, obviously. But I did start feeling dizzy when I stood up and being less resilient, more explosive with people less patient. So, yes, I have had to put that in practice and for me it took a minute, you know, it took about nine months to get it under control and doing everything, and we don't do everything right all the time right.

Speaker 3: 1:13:26

No, that's what we've been talking about. It's a journey lifestyle. It really is.

Speaker 2: 1:13:30

Yeah, I had it too Years ago. Just tons of stress, and I had the kind of POTS syndrome, which is a form of disorder. You come in with that, aren't you?

Speaker 3: 1:13:37

POTS Ritual.

Speaker 1: 1:13:38

Static.

Speaker 2: 1:13:38

Tactic Cardiac Syndrome and it was really kind of crazy. You know, you stand there and talk to somebody and you say I got to go sit down, I'm in faint, you know. And that's when I took the hydrocortisone. I took it for several years and it did definitely help me.

Speaker 4: 1:13:52

I never reached the fatigue. I think I caught myself in like that middle phase.

Speaker 2: 1:13:57

Along with some other things. But yeah, I think to your point, rachel. It's very common and sometimes we don't recognize it because they're in stage one, right. But, yeah, we live in a stressful world these days, for sure.

Speaker 4: 1:14:09

Yes, yes, anything else you want to say, rachel? I just wanted to share a quote that I found and I really tried to apply it into my life. It's once you stop rushing through life, you'll be amazed at how much more life you have time for, because we were always rushing and we don't even stop to smell the roses. I know it sounds so cliche but, we only have this time around. If you know, you're right.

Speaker 2: 1:14:33

So yeah, I would say that you know. As far as I know, we only have one time around.

Speaker 4: 1:14:38

Right. As far as I know, we may have reincarnation, but Right, but then you don't know if you're going to come back as a warm or a costume or something that's right so you got to make this time count, don't you? Yeah.

Speaker 2: 1:14:48

Thank you so much, Rachel, for joining us today and sharing with us your experience and your expertise on this important topic.

Speaker 2: 1:14:52

Yes, I know you well and you've sought out extra educational opportunities, extend your knowledge based far beyond that of a typical nutritionist, and you're an expert at connecting the dots with the patient's problems and their nutritional status. And I know that you treat local folks here in Birmingham, birmingham, alabama, and you also treat folks all over the world remotely. So there's so many people who have benefit from your services. So tell us a bit more about how you and how listeners can find you maybe your web platform and contact info and I just want to let folks know believe in Rachel. I've sent lots of folks to her. They all love her and they've all benefit from services, so I give her the ultimate compliments here. I think very highly of Rachel and so how can these folks get in touch with her, rachel?

Speaker 4: 1:15:35

Absolutely okay. So I have an Instagram channel. It is at FXNutritionByRachel. The website is the same thing FXNutritionByRachelcom. If you want to email me, it's info at FXNutritionByRachel. And my office is currently in Homewood inside a Pilates studio called Provision, and the address is 1-665-28th Avenue South in Homewood.

Speaker 2: 1:16:00

Wonderful Lindsay. Do you have any other pros and wisdom on this particular issue?

Speaker 3: 1:16:04

You know, I really would direct our listeners to listen to Rachel's YouTube channel. I really enjoyed several of your videos on this topic and one of them in particular caught my eye. It was TV is not a stress management technique, and one of the things that you said in that video was just take whatever stress management technique applies to you and do it for five minutes, and do it for five minutes every day, and that was just really powerful to me to think about. Okay, well, what's the one thing I can do that can move the needle just a little bit?

Speaker 4: 1:16:34

Yeah, it's so hard for these moms with small children. Yeah it is hard, I tell them like just lock yourself in the bathroom, tell dad to take the kid for a minute. But you have to do, you know. You have to give yourself permission to take care of yourself. Yes, yeah. You know who my heroes are Working single moms, it's yeah, I mean, how do they do so much for five minutes? You can't tell dad to pick kids right.

Speaker 2: 1:16:56

You cannot. And they're never off right and they're always on guard for those kids. So they are my heroes. Yeah, yeah, Anyway.

Speaker 3: 1:17:05

Don't forget to check us out at McMinnMDcom for more information and get more resources too. We've mentioned a ton in this podcast, and then please do help us grow by telling your friends and family about a share podcast with them that you thought was helpful.

Speaker 2: 1:17:20

If you want to reach out to me by email, you can do so at Dr McMinn at yahoocom. You can also find me on Facebook at facebookcom, slash McMinnMD, and I have all these links for you at the bottom of page one on the homepage at McMinnMDcom. Thank you so much for listening. This is Dr McMinn.

Speaker 3: 1:17:37

And this is Coach Lindsay.

Speaker 2: 1:17:39

Take care and be well railroad and.