Episode 21: The Many Causes of Adrenal Fatigue (Part 2)

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Thanks for joining us for episode 21 of The Ancestral RDs podcast! If you want to keep up with our podcasts, subscribe in iTunes and never miss an episode!

This episode is part two of our 2-hour special on the causes of adrenal fatigue. We hope that our first episode was helpful for you, and not too overwhelming. Sometimes having all this knowledge can cause people to be more stressed than if they didn’t know all the ways that life stress can cause adrenal fatigue so we’re hoping you’ll use this information as a way to make appropriate changes to your lifestyle and not get overwhelmed by fear or thinking that you need to move to a deserted island to get away from all of these potential issues..

Remember, if you’d like to submit a question for our podcast, or suggest a guest that we should host, CLICK HERE.

Here’s what Laura and Kelsey will be discussing in this episode:

  1. How toxins can affect your adrenal health.
  2. The important role of sleep and circadian rhythm entrainment in HPA axis regulation.
  3. The underlying health issues that can cause (and be caused by) HPA axis dysregulation.
  4. How your emotions affect your ability to heal from adrenal fatigue.

Links Discussed:


Laura: Hey everyone. Welcome to episode 21 of The Ancestral RDs podcast. I’m Laura and with me as always is Kelsey.

Kelsey: Hi everyone.

Laura: This episode is part 2 of our 2 hour special on the causes of adrenal fatigue. We hope that our first episode was helpful for you and not too overwhelming. Sometimes having all this knowledge can cause people to be more stressed than if they didn’t know all the ways that life stress can cause adrenal fatigue. So we’re hoping that you’ll use this information as a way to make the appropriate changes to your lifestyle and not get too overwhelmed by fear or thinking that you need move to deserted island to get away from all these potential issues.

Kelsey: I hope that we don’t need to move to a deserted island. I think we can manage it.

Laura: I don’t know. It’s really cold out today and I’m feeling like being on a deserted island right now. It would be really nice.

Kelsey: It does sound kind of nice, get some sun, yeah.

Laura: Yeah. I was joking with Kelsey, you guys would think I look ridiculous right now. I’m wearing basically a down jacket, like a parka kind of thing because I turned the heat off in my house thinking it was going to warm up the next couple days and it’s 40 something out right now. So I’m like shaking in my boots literally, I’m wearing UGGs sitting at my desk.

Kelsey: At least you don’t still have snow on the ground.

Laura: I know, that’s true.

Kelsey: Lucky you.

Laura: Down here in North Carolina, 40 degrees is basically like the tundra. We do not appreciate this weather and I’ll be looking forward to tomorrow when it’s 70 degrees.

Kelsey: Lucky you.

Laura: Dreaming of deserted islands, but hopefully all of our listeners will feel comfortable living where they are living and dealing with the kind of stressors that they’re dealing with in their daily life.

Kelsey: Yeah.

Laura: Let’s get started with taking about, I guess we left off last time talking about a couple of lifestyle habits that could be potentially a problem.

Kelsey: Right.

Laura: Today we were going to start off by talking about different things that maybe you don’t have quite as much control over, but could potentially be something that you focus on as far as your minimizing stress. A lot of times when we think about stress, we think about emotional stress, or over exercising, or drinking too much caffeine, or something like that. But there’s a lot of other things that can actually be causing your body stress that you’re not even aware about.

The first thing we wanted to talk about today was toxin exposure. Toxin is kind of one of those weird words that’s very vague. Toxins can come from the environment, they can come from the food and water that we drink, they can come from the cosmetics or body products that we’re using. It can even from mechanisms that your body is actually performing as a normal function. If your body is doing a lot of metabolizing of nutrients, there is some level of toxic byproducts that can produced in that situation.

Kelsey: Mm hmm.

Laura: If that tends to build up for whatever reason, say you just don’t detox very well.  I think we had talked a little bit about a condition called Gilbert’s Syndrome which is another issue with detoxifying the normal metabolic byproducts that your body produces. Any of this stuff can be considered a toxin.

I just wanted to kind of give a little brief overview of what a toxin is because I think when people think of toxins, they think of like poisons, or air pollution, or water pollution, that kind of stuff. Which those obviously do count as well, but sometimes you don’t even realize the kind of things that are causing toxic exposure.

Kelsey: Right.

Laura: If you are the kind of person that doesn’t detox well, then that can cause a buildup and that will potentially lead to adrenal fatigue. Usually poor detox capacity is actually caused by…there’s a couple different things that can cause it. Genetic defects are usually the most common. Some of our listeners may have gotten the 23andMe test done. One of the things you can get analyzed through that test is your genetic detox capacity. Those results are always a little bit complicated and I have some patients that will bring them to me and they’ll have yellow or red all over the place and I’m like, okay, we just can’t really get too bogged down in those kind of details and we need to just focus on removing the toxic exposures and getting their nutrition status up to par. But sometimes if you do know that you have a detox capacity issue from a genetic standpoint, then you realize that you do have to pay more attention to certain things like water quality, or cosmetic use, and that kind of thing.

Do you have any thoughts about that?  I know I’m sure you look at those test results as well. I don’t know if we know enough about a lot of those test results to make any sort of major recommendations that are pinpointed for a specific polymorphism.

Kelsey: Yeah. I look at them all the time and I really use it as a screening tool because I really think that pretty much everybody should be tested. It’s such an easy test and a lot of times there’s methylation defects and more, like you mentioned. They really do test for a lot that maybe we don’t quite know what to do with that information yet, but that doesn’t mean that we will never know what to do with it.

Laura: Right.

Kelsey: But it’s really common and it’s worth checking because those sort of defects can actually have a lot more implications even beyond detox capacity too. It’s absolutely worth checking out. Anything that’s affecting your body especially with methylation, you kind of need to be able to methylate in order to do the functions the body is supposed to be able to do. When you’re not methylating properly, that in and of itself is a stressor too. Even beyond the detox part of it, just not being able to methylate properly causes stress on the body too.

Laura: Yeah and I think the methylation results are a little bit more, I shouldn’t say well understood because I think the more you learn about them, the more you may realize how complicated it is.

Kelsey: Right. It’s a little more concrete.

Laura: Yeah, it’s a little bit more specific about if you have one specific genetic polymorphism and people know, oh that person tends to have this issue, and here’s the nutrients that you need. It’s a little bit more specific that way. Whereas those detox reports, I don’t necessarily know there’s a whole lot of specific polymorphisms that you can address.

Kelsey: Mm hmm.

Laura: I think like I said, my general thought is that If I see someone give me one that’s a bunch of red and yellow on their detox report, then I just assume okay, detox is obviously something they’re not going to be doing very well so working on removing toxins and supporting the detox functions in the body is going to be essential for them to get better.

Kelsey: Yeah and I think a least where the research is right now, that’s kind of the best thing to do with those results because like you said, it’s just a little tricky to know what you can do beyond that other than just increasing their natural detox capability with eating lots of cruciferous vegetables and things like that which help with detoxification. But then of course, on the other side of that is just reducing as much of the exposure as possible. That’s really key.

Laura: And sometimes poor detox capacity isn’t actually caused by genetic issues. If people are deficient in certain nutrients, they can actually reduce their ability to detox. I know we talk a lot about vitamin C as being an important nutrient for adrenal health, but it’s also another important nutrient for detoxification because it actually helps recycle glutathione which is our master antioxidant and one of our major detoxification enzymes.

There’s a couple of nutrients, like you said the MTHFR nutrients depending on what a person’s genetics look like for that can be helpful. But even if somebody’s low in nutrients like sulfur, or B vitamins, and choline especially are helpful. Like I said, the vitamin C, vitamin E, a bunch of other nutrients that are used for glutathione support could be something that the person’s not getting in their diet enough of.

Kelsey: Right.

Laura: That would be something that maybe your genetics are fine, but your diet is one that is not promoting good detoxification.

Then the other issue that I see in my patients with detox issues is usually something that comes form like an organ dysfunction. Maybe they have some kind of weird liver issue going on, non-alcoholic fatty liver disease is super common these days just because of our diets and then also inadequate choline intake which is a big factor with that disease. If somebody has that, then their liver’s not going to be functioning as well, maybe not be detoxing as well.

Also kidneys obviously do a lot of the detoxification from urine and that kind of thing, so if your kidneys have any issue going on whether that be a chronic kidney disease, or if there’s some kind of autoimmune kidney issue, or if you have recurrent UTIs, or anything like that, then there may be some level toxic buildup if the kidneys aren’t able to function as well as normally.

Kelsey: Yeah, absolutely.

Laura: But like I had said, the toxins, I know I keep saying that and I’m not the kind of person that likes to use these vague woo-woo terms when it’s like, oh toxins, and you have to detox yourself. I don’t think people need to specifically go on these crazy detoxes or go on a juice cleanse.

Kelsey: Yeah, you don’t need to cleanse.

Laura: Yeah. But it is good to know where toxins may come from so that if you’re getting exposed regularly for whatever reason, that you know that there’s ways to get rid of that exposure so that your body doesn’t have quite as much of a load to deal with. Like I had said before, a lot of the ones that we think about are things like heavy metals, so lead and mercury. A lot of times people have mercury fillings so that can potentially be an issue. If you have lead paint or something in your house, which I think most people don’t.

Kelsey: Hopefully.

Laura: There’s always that possibility if you live in an older house. Or if say you have mold growing in the house, that’s a big one that I’ve seen. Like I had said before, chemicals in our toiletries, so face care, shower products, that kind of thing.

Kelsey: If your water has toxins in it for whatever reason, whether that’s something that your water treatment company is putting too much chlorine in your water, or something like that, or if it’s just your pipes are eroding and there’s metals getting into your water.

Same thing goes with foods. If there’s pesticides on your food, if there’s heavy metals in your food, so something like arsenic in rice or something. There’s lots of different foods that have toxins in them.

Laura: Also another one that I see a lot is pathogenic gut bacteria producing toxins.

Kelsey: Mm hmm, yeah, absolutely, right.

Laura: That’s one of those things that people don’t even realize is potentially leading to a high toxin load and that’s because pathogens in the gut produce toxins when they’re just metabolizing the food that they’re eating. Also if your body’s killing any pathogens, the type molecules in their cell membranes can be toxic. They’re called endotoxins or exotoxins. Exotoxins are usually what the cell membrane is made out of. Endotoxins are things that are inside the cell or if it’s something that the bug is producing as a normal metabolic output.

Kelsey: They’ve done studies actually on rats that show that being exposed to endotoxin activates the HPA axis, which makes sense of course because it is a stress load on the body that it has to deal with because it really shouldn’t be there. But it’s interesting to know that they’ve actually seen this happen so it’s kind of a proven fact that this happens.

Laura: Yeah, and it’s crazy because obviously we can’t all control what kind of bacteria are in our guts, but if we have unhealthy guts and you have bacteria that producing these toxins, then like you said, it’s activating the HPA axis. I’m pretty sure it also can lead to leaky gut.

Kelsey: Yeah, absolutely.

Laura: Even if the endotoxins themselves aren’t activating the HPA axis, then if you have leaky gut, then those food proteins can stimulate an immune response and cause HPA axis issues. That’s why we really always recommend eating a diet and eating fermented foods that will help support gut health and also good gut bacteria.

But if you have a gut infection, then that would be something worth getting worked on with a practitioner who can help you deal with that. Because that’s again, you can’t really necessarily get rid of those toxins without getting rid of the infection.

Kelsey: Right.

Laura: That could be the underlying cause of what’s kind of throwing your whole system off.

Also substance abuse issues, so alcohol and cigarette smoke. We’ll talk about that in few minutes, but that’s another potential source of toxins. I feel like most of our listeners probably aren’t drinking tons of alcohol, or smoking cigarettes, or anything like that.

Kelsey: Still worth mentioning.

Laura: If you are or maybe if you used to, I mean I went through college and I think about how much I used to drink in college and I’m a little bit sometimes shocked that I could even tolerate that. But sometimes I think that may have had some role in some of the health issues I have. If it’s in your past, it can certainly cause issues right now. So you just have kind of look at everything that can potentially be an issue.

Kelsey: And especially when it comes to HPA axis issues because a lot of times people will have had this period of their life where either they had really high emotional stress, or maybe were abusing alcohol for a period of time. Or even abusing could potentially be a strong word, but just drinking a lot more alcohol than they currently are. And all of those things can kind of kick those things into gear with HPA axis dysregulation and then it takes a long time to recover from that. Even if it’s in your past, it definitely could of kind of kick started the whole process.

Laura: Yeah, definitely. Like I said, we’ll talk about the substance abuse issue just because there are some people who that is an issue for and I don’t want people to feel like they should be ashamed of it or anything. I just was assuming that most of our listeners probably since they are more health conscious that that might not be something that they deal with.

Kelsey: Right.

Laura: But you can really get exposed to heavy metals through a lot of different things. Like I said, lead is one of those things actually that they do put into pesticides sometimes. So even if you’re not living in an old house, if you’re eating non-organic fruits and vegetables, that could potentially expose you to lead. Sometimes older cooking utensils will have lead in them. So again, if you’re using any sort of hand me downs, if you bought a pan at a thrift store or something, it’s possible that it could have some heavy metals in it. Like I had said with cigarette smoke, cadmium and lead is in that. Even if you don’t smoke yourself, if you live in a city or live with a roommate that smokes, then getting exposed could be a problem.

I had mentioned the mercury in the dental filings. Mercury in fish could potentially be an issue, but I don’t think it’s quite as much of an issue as people as tend to make it out to be.

Kelsey: Right.

Laura: Then aluminum in things like antacids, and aluminum cookware, and then soda cans, or any sort of aluminum canned goods. Getting a lot of heavy metals in your system from those kind of exposures is possible. If you’re not detoxing well, then that can definitely buildup.

Kelsey: Yeah.

Laura: Like I had said, I don’t want to freak people out by telling them all this stuff. I mean, all of us are exposed to toxins all the time. Our bodies are able to handle the majority of these toxins. It’s unfortunate that our society is kind of more toxic than it would have been 100 or 200 years ago, but all you have to do is do your best to try to limit your exposure and make sure you’re supporting your body in a way to make the detox capacity as good as it can be.

Kelsey: Yeah, because it’s not worth freaking out over it.

Laura: Yeah.

Kelsey: We talk about stress and how that is absolutely not good for your HPA axis. So really you can think about it that way. It’s just simply not worth stressing yourself out over something like this that you don’t a huge amount of control in.

Laura: Right.

Kelsey: You just do the best you can and that’s all we can ask, you know?

Laura: Yeah. So as far as dealing with toxin exposure if you have adrenal fatigue, or if you’re just concerned about preventing adrenal fatigue, it’s a good idea to limit your exposure to toxins by eating nutrient dense organic foods. Again, trying to avoid pesticides and also getting the nutrients that you need.

Drinking purified water, even if you have a pretty good tap system in your county or wherever you live, sometimes it’s good idea to further purify that water because again, you never know if say your pipes are leaking some kind of metal into it or something like that.

Eating fiber, so adequate fiber can help excrete any gut toxins that you have. Those could be the toxins that are being built up from poorly balanced gut bacteria, could be from medications, any sort of toxins that are building up in your gut can actually be almost flushed out because they get bound to the fiber that you eat. Eating lots of fruits and vegetables could be helpful there.

Avoiding air pollution as possible. It really depends where you live. I mean if you’re in the middle of the country you may not have a huge issue. But if you’re in a major city, that may be something. Kelsey, what do you do about air pollution living in New York?

Kelsey: Not much you can do about it, unfortunately.

Laura: Yeah.

Kelsey: It just comes with the territory. I try just not to stress myself out over it and do everything else that I can to reduce my toxic load. That’s really all you can do.

Laura: You don’t walk around the city with a dusk mask on?

Kelsey: You know, I don’t. A little too severe for me.

Laura: I would think that with air pollution that maybe having plants in your house or putting an air filter in your apartment if you do live in a place that’s got a lot of air pollution so at least you’re not breathing it in in your house.

Kelsey: Exactly.

Laura: That could be helpful.

Kelsey: Leaving your shoes outside either your apartment or your home. Kind of taking them off and leaving them in the front of your house is actually been shown to reduce toxic load as well.

Laura: Oh wow.

Kelsey: So that’s a good idea. Pretty interesting. You wouldn’t think that, but it actually does.

Laura: Makes sense. You get the double benefit of keeping your housel clean.

Kelsey: Exactly, you don’t have to vacuum as often.

Laura: That would be good for me. I hate vacuuming.

Another option is sweating. You can either go to a sauna and get some sweat out that way, or if you exercise and you sweat when you’re exercising, that can help excrete some toxins. It’s not going to be anything crazy. I know people think that if they’re on these detox plans that sweating is going to help them totally purify their body. It’s not really at that level of detoxification. Really it would be more if there’s anything that’s kind of in your pores from say the environment. But like we said, air pollution if you’re outside and then you do some sweating, some of that can help get rid of that so it doesn’t get absorbed into your bloodstream. Getting a little bit of sweating going can be potentially helpful.

Also switching to more natural skin and body care products.

Kelsey: Yeah.

Laura: That’s one thing that I am definitely not an expert in. There’s lots of people out there that write lots of great information about both body care and then also home care products that are more natural. I don’t want to go too deep into that because like I said, I don’t have a lot to say about it.

Kelsey: There’s a lot to say about it too.

Laura: I know. There’s lots of online guides there. And then again, avoiding alcohol and smoking, or limiting alcohol I should say because not everyone’s going to avoid it 100%. But we’ll talk about that in a few minutes.

Just as far as boosting your detox capacity because like we said, it’s not just about your toxin exposure, it’s also about your body’s ability to deal with the toxins. You can do this by taking additional B vitamins, getting some extra choline in your diet. Egg yolks and liver are the best source of choline. Some of my patients take glutathione precursors. Like I said, the precursors or maybe they even take liposomal glutathione so that can potentially boost your glutathione capabilities.

Kelsey: Also add here too just in terms of diet, eating more cruciferous vegetables, like part of the brassica family, that’s been shown to increase biotransformation, which is basically we say detox, but it’s actually biotransformation because what we’re doing is transforming toxins into less toxic things or things that we can get rid of through urine, or sweat, things like that.

Laura: Right.

Kelsey: It kind of increases that biotransformation ability.

Laura: Yeah. Those kinds of vegetables include things like broccoli, and cauliflower, Brussels sprouts, any of those kind of cruciferous vegetables that unfortunately a lot of people are sometimes afraid of because of fears over hypothyroidism and that kind of thing. Certainly you don’t want to be eating a ton of raw cruciferous vegetables all the time, but if you’re eating cooked ones and eating some raw but not a ton of raw cruciferous, you should be fine.

Kelsey: Yeah.

Laura: And then also using liver supporting herbs and supplements. So again, if you’re somebody that has liver issues or elevated liver enzymes, sometimes there’s some herbs that can help support the liver in its health and also its ability to detoxify the blood. If you are somebody that is dealing with liver issues, certain herbs like dandelion root, or burdock can help get things moving in a way that prevents things form building up.

Then like we had said before, getting your genetics testing for MTHFR and any sort of detox, they’re called single nucleotide polymorphisms, which we sometimes call SNPs, that can help you identify if you need additional support above and beyond the average person.

Like I said, there’s a lot of ways to both reduce toxic exposure and improve detox capacity. It’s a good idea for anybody to do this, but also especially people with adrenal fatigue. You should hopefully be able to do both by improving your diet, by reducing your exposure, and taking some supplements as necessary.

Kelsey: Absolutely. Yeah, and to go back a little bit what we were talking about before which was alcohol, and smoking, those kinds of things, that’s actually been shown to cause HPA axis dysregulation. Interestingly with alcohol actually, they’ve shown that it reduces your heart rate variability. You actually want to have a lot of heart variability, which just means it kind of is an indicator that you can react to stress appropriately and that you’re not very stressed out to begin with is I guess is probably the best way to describe that. They’ve shown that in people who abused alcohol that their heart rate variability is reduced, so they’re not responding to stress as appropriately as they should, which is of course an indicator of HPA axis dysregulation.

Then they’ve also shown that alcohol abuse increases cortisol levels. When we talk about how the HPA axis kind of gets dysregulated, what happens is that, especially with chronic stressors like alcohol abuse, you’re drinking too much alcohol, the body is not meant to be able to biotransform that alcohol into something that we can handle as much as someone who is an alcohol abuser is drinking. So what happens is that the HPA axis is chronically activated or it’s chronically getting stimulated because of that alcohol pretty much coming in a on a regular basis and it can’t handle that.

Eventually when the HPA axis is chronically activated, the first step in that process for the hypothalamus to release ACTH, and that’s the beginning of the stress response. What they’ve shown is that ACTH levels go up and then cortisol levels as a result of that go up as well. They’ve shown that people who are alcohol abusers, they end up having really high cortisol because they’re chronically activating the HPA axis. So it really does mess with the HPA axis regulation. Of course as we know with adrenal fatigue, that’s the beginning of adrenal fatigue. That would be considered stage one adrenal fatigue when someone’s cortisol levels are high like that.

Laura: Mm hmm.

Kelsey: And then smoking kind of does similar things. Basically what they’ve shown with smoking is that it reduces the responsiveness of the HPA axis. What that really means is that since smoking, like Laura was mentioning, it has a lot of toxins in there so the body has to deal with the higher toxic load and what that does is it activates the HPA axis chronically. Eventually the HPA axis kind of gets fed up with this situation. It feels like it shouldn’t be chronically activated so it kind of reduces its response to any sort activation. You’ll actually see lower levels of ACTH, which again is that beginning of the stress response that eventually leads to cortisol production.

You see lower ACTH levels which means that the HPA axis is no longer really responding to stress because it’s just like well, all this stress is coming in all the time, what am I supposed to do about it? I can’t be chronically pushing out cortisol all the time. So that’s when you start to get more into the stage two and stage three of adrenal fatigue where the HPA axis is just kind of giving up. It’s saying I can’t really handle this amount of stress, so I’m just going to cool it for a little bit.

Laura: Yeah, I think that was pretty similar to what we were talking about with over-training in the last episode.

Kelsey: Right.

Laura: You have this chronically elevated cortisol, you have chronic stimulation of the HPA axis, and eventually it’s a survival mechanism that HPA axis stops responding as well. Because like you said, if it’s just constantly going, and there’s really no variation, and you’re not having that acute stressor, and then the break, and then the acute stressor, and then the break, if it’s just constant chronic stress, then the HPA axis is like…and we keep talking about it like it has a brain or something. It’s not this little creature in your head that is deciding oh I’m sick of this, I’m going to stop producing cortisol. But we like to talk about it that way because it makes it a little less…

Kelsey: It makes it easier to understand.

Laura: Yeah, if you can think about it as trying to prevent there from being excessive cortisol all the time, which in itself can cause issues. It is an adaptive response by the HPA axis which unfortunately like you said, once it develops into stage two or three adrenal fatigue, that’s where you’re not producing cortisol even when you need to.

Kelsey: Right.

Laura: So that’s the problem that develops there. It’s interesting that smoking and alcohol use can do that because again, there’s so many things that can chronically activate the HPA axis, that’s kind of what we’re trying to help you guys work through is all the different things that do stimulate the axis and to figure out okay, what can I remove out of my life, or adjust in my life to make sure my HPA axis is not firing all the time.

Kelsey: Right. I would say in the case of alcohol, a lot of us probably drink alcohol moderately and I think that is fine. However, if you are in the midst of dealing of with some pretty severe adrenal fatigue, it is something to maybe consider pulling back on at least for the time being so that your body is just not getting additional stress that it doesn’t need of course. I would hope that most people who are health conscious and everything are not smoking. But if you are, definitely worth quitting absolutely because it does a lot that is harmful to your health and if you’re focused on adrenal health especially, it’s really just dysregulating the HPA axis entirely. So defianatly not a good idea.

Laura: Okay. So another lifestyle factor that I’m sure all of us deal with on occasion, or all the time depending on the person, but that would be sleep deprivation and staying up late. Kelsey do you want to talk a little bit about that?

Kelsey: Sure. This of course is really, really common in our society today. They’ve done research studies that show that about 1/3 of us get less than 6 hours of sleep a night.

Laura: Wow, really?

Kelsey: Yeah, right? That’s pretty significant and that’s a good chunk of us that are really not getting a lot of sleep chronically. Most of us probably know that sleep is an absolute requirement for proper health. Knowing that there’s a lot of us that don’t get enough sleep, and “enough sleep” is somewhat debated, but generally that’s about 8 hours is usually what people will say. I think most people when they actually sleep to when they wake up without an alarm, it then really is about 8 hours as they’ve been sleeping prior tot that. If you were sleep deprived and then you just sleep as much as you wanted, you probably would sleep more.

Laura: Yeah. There’s always a few people that sleep less.

Kelsey: Yeah.

Laura: I know the naturopath I work with says that she prefers 7 hours a night. If you’re that kind of person, don’t feel like you’re causing adrenal fatigue by sleeping 7.

Kelsey: Exactly.

Laura: But just be aware that I would say 7 -9 is probably a decent range.

Kelsey: Yeah, that’s the range I like to give. For those with adrenal issues, I definitely want to see them on the end of that spectrum, so closer to 9 if they need it. Or sometimes even more than 9 if they’re dealing with really significant adrenal fatigue, it’s absolutely possible that they’ll need 10 hours of sleep a night to really start to recover.  It really depends, but generally for a healthy person you want to be getting 7 to 9 hours of sleep every night.

To know that a 1/3 of us are getting less than 6, I mean that’s really significant. What we’ve seen with sleep restriction is that it course activates the HPA axis. I’m sure everybody probably could have guessed that by now.

Laura: Shocker.

Kelsey: I know, right? Who would have guessed? But it alters the production of ACTH, again that beginning of the stress response, and the production of cortisol which is our stress hormone and kind of the end result of the HPA axis being activated.

This is somewhat slight at the beginning. So let’s just say you got one night where you really didn’t sleep well, you maybe got 6 or 5 hours of sleep, something like that. It’s not going to be the end of world. Your body just says okay, the HPA axis is activated, you’re going to produce a little bit more cortisol, a little bit more ACTH, and that’s perfectly fine. As long you give yourself the opportunity to sleep enough the next night, your body kind of recovers from that.

But that’s different when it becomes a chronic issue which is the case for a lot of us. We’re really just not getting a lot of sleep on chronic basis and we’ll maybe not get enough sleep during the week and then kind of sleep a lot on the weekends. And that kind of thing can really mess with the HPA axis because first of all, anything that’s a chronic stressor of course, I guess you all can probably guess by now that that definitely leads to HPA axis dysregulation over the long term. The longer that sleep restriction goes on, the worse the HPA axis dysregulation gets.

I like to always tell people, whether they’re in adrenal fatigue or not, to try to be pretty regular with how much sleep they’re getting. Don’t make your weeknights be 6 hours of sleep and then your weekends be 9 hours of sleep. You should try to generally get, again, that 7 to 9 hour range every night, and try to go to sleep the around the same time every night and wake up around the same time every morning. Of course that’s not going to be perfect, but as close as you can get to that, I think the easier it is for your body to handle changes in your sleep schedule and of course your circadian rhythm too.

Laura, I know you had a little bit to say about the circadian rhythm connection. This is probably a good opportunity to throw that in here.

Laura: The circadian rhythm thing, I swear is related to almost everything. Again, stress and circadian rhythms, both of those could probably be related to any condition that we talk about. But when we were researching for this podcast, I found an article that talked especially about how circadian rhythms actually interact with the HPA axis.

I guess I should try to explain what a circadian rhythm is if people don’t know. Basically, with the 24 hours in a day that there are, our bodies have different production of hormones that are mostly related to light exposure. There’s other things that can affect circadian rhythms, but the biggest driver of that is light exposure. Generally we get light exposure when the sun comes up and then the lights are gone when the sun goes down. Of course with our modern technology, a lot of times we’re seeing light a lot longer than we should be at the wrong times. If somebody’s a night shift workers, then they’re completely backwards as far as when they see light in the nighttime and they see dark in the daytime.

Like I said, there’s a couple of other things that affects circadian rhythms. But basically the circadian rhythm or they also call it the clock system is a way for the body to coordinate its hormone production and release. Essentially you have cells say at the bottom of your feet that need to be on the same schedule as the cells at the top of your head, and the only way they can really do that is by having internal clock systems that kind of keep everything running at the same time. Your cells will produce certain molecules or certain hormones at specific times. Melatonin is a really good example of that were the lights go out and then your body starts to release melatonin.

Cortisol is actually another good example of a circadian rhythm directed hormone.  As some people may be aware if they’ve gotten their cortisol tested, cortisol tends to be high in the morning and low in the evening. That’s something that you should see a pretty much consistent, I guess it’s a sign curve. I’m trying to think of the exact structure of the fluctuations, but it should basically go up and then down, and up and down, and it should kind of go exactly with that 24 hour cycle.

It’s really interesting just because like I said, there are so many things that can affect our clock system and with light being the primary driver of that, we do some many things that disrupt our light and dark rhythms that there’s kind of no reason why any of should have properly functioning HPA axis.

Kelsey: Right, it’s surprising so many of us are actually having normal HPA axis.

Laura: I know, if we even do. I mean it’s so funny. I think most people probably wouldn’t even think to get it tested unless they have severe symptoms.

Kelsey: Right.

Laura: But there’s so much evidence about the clock system affecting things like metabolic syndrome, so insulin resistance, immune diseases, so people will be at higher risk for cancer, they’ll be at higher risk for things like depression, and anxiety, and heart disease if they’re totally dysregulated with their circadian rhythm. That’s usually people like I said before, shift workers, people who suffer from constant jet lag, which that could be flight attendants, pilots, that could also be people who do a lot of business travel. Basically any dysregulation or disruption in either system, so either the clock system, the circadian rhythm that I was just talking, or the HPA axis system. Either of those if there’s dysregulation can cause hypercortisolism and that can lead to the development of these metabolic and immune diseases.

Long story short, again, Kelsey and I were joking about this before we got on the call that we should write a post about this because it could really be a pretty in depth investigation.

Kelsey: Yeah.

Laura: And just how much role that the circadian rhythms play in our HPA axis function…you were talking about getting 7 to 9 hours of sleep per night. And even if you’re getting 8 hours of sleep per night, if you’re going to bed at 1 in the morning and waking up at 9, that is not the same thing as getting to bed close to when it’s dark and waking up close to when the light starts to come up.

Kelsey: Yeah, it acts very, very different. There’s so many studies on shift workers because they’re just such an interesting population now because it’s just completely opposite from what we would have done, our ancestors, and modern tribes even now do because their lives are just so connected to the sun and the cycle of the sun and the moon. So it’s just really interesting to study this population because again, they’re just so opposite from that and we want to kind of see how it affects a human body. From has been shown so far, it really does not do very good things to it. Like Laura mentioned, it can absolutely dysregulate the HPA axis along with the circadian rhythm.

So the two are just so, so tired together because as Laura said, if you think about cortisol, you’re supposed to have the highest amount of cortisol in the morning. It wakes you when you have that high amount. Then over the course of the day, it goes down, down, down until you fall asleep. It gets a little bit lower during sleep, and then it starts to rise up again as really when the sun should be kind of coming up, and then wakes us up in the morning again, and starts the cycle over again. It’s all very cyclical and whenever you start to mess with those cycles, things really get out of whack.

Laura: Yeah, and I don’t know if you’ve ever seen patients like this, but I’ve had patients before where their rhythms were almost completely backwards.

Kelsey: Yes, exactly. Really low cortisol in the morning and super high cortisol at night. Yeah, 100%.

Laura: I would think that that could potentially have to do a lot with circadian rhythm disruption.

Kelsey: Mm hmm.

Laura: That more so than having chronically elevated or chronically low cortisol. Because the two common patterns that you’ll see is you have that curve that is normal and then you’ll see someone that has the whole curve is just moved up so they’re just having high cortisol the whole day, or maybe part of the curve is higher than it should be.

Kelsey: Right.

Laura: You’ll also see people that whole curve is shifted low so you’re still having some level of cycle, but it’s lower than it’s supposed to be. Then the level three is where it’s just basically, I mean I call it flat lining, but essentially there’s not much of a cycle and it’s just flat. But then there’s this other weird pattern where they’re having what kind of pattern they’re supposed to have, but it’s just totally like 12 hours off. So they’re having that drop in the morning and then high at night. I almost think that can almost be even worse because then that messes up their ability to fall asleep at night.

Kelsey: Yeah.

Laura: Everything just gets kind of screwed up from there. Again, if you had a cortisol test done and you see a pattern like that where it’s low in the morning and high at night, I would strongly recommend focusing on circadian rhythm entrainment. Paul Jaminet has a lot of really good information about that in his book called The Perfect Heath Diet. So that would be the primary resource I’d look into if that’s somebody’s issue.

Kelsey: Just generally kind of reducing your exposure to light at night. Don’t watch TV, or use orange glasses, use computer programs that block the blue light, all that kind of stuff if you have to or if you are using electronics at night. And then getting sun exposure right when you wake up is a great idea because a lot of us unfortunately don’t get that exposure in the morning. That can be equally as negative an effect as being exposed to blue light at night. You kind of want to make sure you’re getting both ends of the spectrum taking care of too.

Laura: Yeah, that’s always something I have with my patients who will say oh I have such a hard time getting out of bed in the morning. And I’ll talk to them about their sleep hygiene and all that and they’ll say I’m using black out shades and I’m doing all this stuff to get ready for bed. But then they don’t open the shades in the morning.

Kelsey: Right.

Laura: I’ll just tell them, okay listen, when you wake up just open the shades. And I know you’re tired, but just get up and open the shades. You can get back in bed if you have to, but just have that sunlight coming in. It’s amazing because they’ll come back in a couple week and they’ll say, I can’t believe how much better I feel waking up in the morning.

Kelsey: Right.

Laura: I have the same problem. If I don’t open the shades in the morning, it’s really hard to get up. So I make it a point even if I’m feeling still tired whether I stayed up too late the night before, if I had a stressful day the day before and I’m super exhausted in the morning, if I just open the shades and have the light coming in, no pun intended, it’s like a light switch went off in my head and it just makes me so much more energized.

Kelsey: Yeah, and I also recommend too especially if things are really, really off that people try to get outside in the morning as close to when they wake up as possible and just either go for a short walk and get some sun exposure, or if they have a deck or some sort of outdoor area where they can be exposed in the sun, just sitting out there with their breakfast or something like that can really help too just train that circadian rhythm again too.

Laura: The most important factor is the actual light in your eyes. If it’s super cold out and you can’t physically be outside because it’s too cold, just sit by a window.

Kelsey: Exactly.

Laura: That’s really all it takes. It’s not the same thing as vitamin D production, you don’t have to be in the sun with sun hitting your skin to get the circadian rhythm entrainment. Although I do that could potentially help just based on what some people talk about vitamin D as a hormone.

Kelsey: Yeah.

Laura: We have to actually either do a podcast on this or article because there’s so much information about it, that could be helpful.

Kelsey: There is.

Laura: I don’t want to talk too much about it because we have a couple of other things we want to talk about. But long story short, if you’re not entraining your circadian rhythms appropriately, then that in itself can lead to HPA axis dysregulation. I would actually think that that would be one of things we talked about that could be like a sole factor of HPA axis issues.

Kelsey: Exactly, I agree with that.

Laura: It’s like we had talked about how most of these issues are not in and of themselves going to cause adrenal fatigue, but I actually like I said, I think….

Kelsey: This is one of the ones that probably could.

Laura: Yeah. It’s weird because it’s not something we talk about a lot, but it’s something that is very important. Again, hopefully there will be an article along the way that explain this in a little bit more detail.

Kelsey: Exactly. Alright. Should we move on to the next topic here?

Laura: Yeah, since we’re 45 minutes in, so we want to get through all of this so don’t have to do a part three.

Kelsey: Exactly. Next we’re going to talk about some underlying health issues that can feed into HPA axis dysregulation as well. The first one of those that we want to chat about here is autoimmune disease. Laura, I’m going to let you talk a little bit about that.

Laura: This is actually something I am writing an article about. I don’t know which one will come out first. It’s possible the article may already be available by the time you’re listening. But if it’s not, then it will be available in the next couple days. I’ve been working on an article about how stress can actually cause autoimmune disease, but actually it can kind of be one of those cyclical issues where stress can cause it and then autoimmune disease can cause worse stress.

Basically, the cortisol production from the HPA axis is something that’s used for inflammatory control. Beyond just energy and that sleep, wake cycle that we were talking about with cortisol playing a role there, it also helps with controlling inflammation. So if you have high inflammation, usually you’ll see somebody also has high cortisol at the same time. But the interesting thing about autoimmune disease is actually you see the opposite. So you see high inflammation and low cortisol.

I know we are talking causes of adrenal fatigue, so it’s a little tricky because again, it’s one of those things that it’s not very clear what causes what. But they do find that people who have more HPA axis dysregulation in autoimmune disease actually have worse symptoms. They studied for example people with multiple sclerosis. They tend to all have high cortisol, but if they have low cortisol which would be more of a stage two, stage three type situation, they actually have far worse symptoms. So it’s a more severe disease, they also have more active lesions in the brain.

It’s just interesting because you would think okay, high inflammation, that’s usually high cortisol. But it starts with high cortisol and then it gets lower, and then when it gets lower is when the inflammation gets out of control.

Kelsey: And if you think about it, it does actually kind of make sense too because cortisol fights inflammation. If you are chronically activating the HPA axis at first because there’s a lot of stressors that go along with having an autoimmune disease, your cortisol is high for a while so maybe your symptoms are maybe a little bit more under control because the cortisol is maybe at least somewhat equal to the amount of inflammation. They’re both kind of fighting each other and maybe neutralizing each other a little bit. Then when cortisol starts to get low because it fights inflammation, if you don’t have the cortisol there to fight the inflammation, the inflammation is going to go crazy.

Laura: Yeah.

Kelsey: In that case, you can kind of understand why at that point you’d see a lot more symptoms in someone with MS, or really any kind of autoimmune disease because the inflammation is just going rampant and causing a lot of those symptoms.

Laura: The other one they’ve done a lot of research in is rheumatoid arthritis. I don’t know why specifically RA is so popular in the research with HPA axis dysregulation, but they found it to be not only a trigger but also an indicator of how severe the disease will be. People with HPA axis issues and RA, they’re going have worse symptoms because of that inflammation. And then of course, having an autoimmune disease is…I don’t have an autoimmune disease, so I’m just speaking from my clients’ experience. It is very stressful to have an autoimmune diseases.

Kelsey: Right.

Laura: If you’re having that underlying inflammation that’s already happening and you’re having the mental stress of having an autoimmune disease, that could be contributing to HPA axis issues. Then also, certain conditions like Celiac disease, or IBD, Chron’s, or ulcerative colitis can potentially cause malabsorption of nutrients. As we had talked about before, if you’re not getting adequate nutrition, that’s going to potentially affect your HPA axis.

Kelsey: Exactly.

Laura: It’s like everything’s kind of holding hands with each other and if one happens, the other can develop, and then that development can exacerbate the HPA axis issue. We’re trying to like I said, get people aware of what can potentially contribute to adrenal issues and hopefully have some ideas about how to avoid stuff. Of course you can’t avoid having an autoimmune if you have it already, but working on stress management can help reduce the impact of that autoimmune disease on adrenal issues.

Kelsey: Right, because especially if you’re in the later stages of adrenal fatigue and your cortisol is low, as much as you can do to retrain the HPA axis and start to make more cortisol and start to have your HPA axis kind of respond normally to stress rather than chronically being stressed, the better your body is going to be able to deal with the autoimmune sort of situation because you’re going to have more cortisol to fight that inflammation.

Laura: Yeah. It’s interesting, and like I said, I’ve written this article and so this will be available and whenever I post to it I will link to it in the show notes. But there’s also information about chronic HPA axis activation causing imbalances in the TH1 and TH2 cytokines balance. That is something that a lot people have written about how that can affect inflammatory and autoimmune conditions. If you’re TH1 or TH2 dominant, there’s different diseases that are associated with each of those specific cytokines. They’ve actually shown in mice studies that if they have high stress exposure, that those TH1 TH2 cytokines get imbalanced.

There is some information about different herbs and medications that can help resolve some of that imbalance. Even though taking those herbs can be helpful, if you’re not dealing with stress management, then I wouldn’t think that the herbs would be enough to kind of overcome that stress influence. Again, it’s more of what can HPA axis issues cause? But I just thought that was really interesting how the balance of cytokines can actually be affected by HPA axis issues.

Kelsey: Yeah, that’s really interesting.

Laura: Cool. I think the other thing we wanted to talk about, well not the other, one of the other underlying health issues that is a big issues for a lot of people, and I actually myself had this issue so I can talk a little bit about it unless Kelsey wants to talk about the whole thing, but chronic infections.  When we talk about chronic infections that can be some kind of gut pathogen like we had talked about before, that can be Lyme Disease. Lyme Disease is what I was talking about when I said that was something I had. I don’t know if I’ve mentioned that on the podcast before.

Kelsey: I think you have.

Laura: Okay. I have no idea.

Kelsey: It might have been a long time ago.

Laura: It’s just funny because it was a while ago that I was dealing with it. So it’s like sometimes I forget that I had it and then people ask me what did you do? And I have to remind myself of all the medications I was taking, that kind of thing. I’m like, oh yeah, I had Lyme Disease, I forgot about that.

Do you want to talk about, I guess you had some information about gut pathogens that could potentially cause issues.

Kelsey: Yeah. I think this can be sort of applied to any infection really. But I think the most research that’s been done on this in relation to the HPA axis, it has been done on different gut bacteria issues because as we know, that’s becoming a very hot topic these days.

What’s really interesting about gut bacteria is that as probably a lot of us know, we get colonized with bacteria going through the vaginal canal when we’re born, we get it through breast milk. So there’s a lot microbial colonization that happens after we’re born, or kind of during the birth process. What that does is it actually programs the HPA axis. That’s to say that what bacteria we’re exposed to and what we are colonized with during and after birth affects how the HPA axis is programmed to react in the future. Which is really interesting because of course we have no control over it because well, we were born and we didn’t really have a lot to say about that. What we were exposed to is more related to our mother and of course we can’t really do anything about that either.

But what you can realize is that maybe if you were born via C section, or if you weren’t breastfeed, that potentially your gut bacteria is not as diverse, you maybe don’t have some more of the really important strains, you are potentially more likely to have dysbiosis which means an imbalance of good and bad bacteria in the gut. All of those things affect how the HPA axis reacts. If you know that you are more likely to have HPA axis dysregulation because maybe you were born by C section, or your weren’t breastfed, or things like that, then you kind of know that you probably have a predisposition to developing HPA axis issues, and so you know to pay a little more attention to that. Me saying we can’t really do anything about it, I just mean that in the sense of course there’s nothing we can do to change the past, but knowing what the past is can help us better prepare for the future.

Laura: You mean we can’t go back and change the way that we were born?

Kelsey: I know, darn. It would make life so easy.

Laura: Yes.

Kelsey: I just think that’s really interesting. They’ve shown with rats, a lot of these studies of course are done on rats since they really don’t want to alter the gut bacteria of humans too much because we don’t really know how far those effects can reach. From what we’ve seen with research on other animals, it kind of sounds like that can really be far reaching in its affects. They’ve done studies on rats that have shown that altered gut bacteria itself, whether or not that happens when we’re born or if it happens later if you get a pathogen or like I said, get dysbiosis later in life, just that alteration of the gut bacteria itself causes HPA axis dysregulation.

That altered gut bacteria really what I’m referring to is an alteration in a negative respect. Getting more bad bacteria than good bacteria, or getting a pathogen, or developing SIBO, something like that. I don’t really think that having a lot of great bacteria, if you had not so good bacteria would have a similar negative effect on the HPA axis. It’s really the kind of things that we talk about a lot on our podcast and we hear a lot about in the Paleo world, this alteration of the gut bacteria in a negative way also has a negative impact on the HPA axis.

Laura: Mm hmm.

Kelsey: Really the brain and the gut, it’s a two way street. I think we kind of talked about this before and this is true for a lot of other parts of body too. But whatever effects the gut, affects the brain, and vice versa. If you are dealing with a gut infection of some kind or really any infection, so this could apply to Lyme or really any other infection as well, you really need to fix both things at once if possible. It’s really better to do it together if you can, if you recognize both are going on at the same time because you’re more likely to able to truly heal from both of those things if you deal with them together.

If you just try to deal with stress and hope that that heals your HPA axis and that in turn will heal your gut, unfortunately it really doesn’t work that way because anything that’s going on in your gut if you have an infection, that’s also going to be negatively affecting the HPA axis and serving as an additional stressor that you’re not doing anything about. You kind of have to deal with both things together if at all possible.

Laura: Yeah. Even sometimes I think stress management is the side of things that people don’t focus on enough as we had talked about last time.

Kelsey: Right.

Laura: With the Lyme issue, just from my own experience, I feel like that is another situation where it’s not clear what comes first because when I was dealing with Lyme I had a lot of fatigue, a lot of joint pain, that kind of thing, which again, sounds a lot like adrenal fatigue. If you look at some of the symptoms, they’re very similar.

Kelsey: True.

Laura: There was probably a decent amount of inflammation going on. When I say I had Lyme, I use past tense because I don’t think I have active Lyme anymore, but honestly I have no idea. I haven’t been under any sort of treatment for it in a couple years. But my general lifestyle decisions are with the understanding that I’m not in perfect health and I try to deal with the kind of health issues that I have. But if somebody has chronic Lyme Disease with the inflammation issues with the kind of chronic fatigue, and joint inflammation, that kind of stuff as we had talked about before, it’s really no different than any of the other issues we were mentioning.

Kelsey: Exactly.

Laura: Dealing with Lyme Disease, that’s like a huge Pandora’s Box. I won’t talk too much about that.

Kelsey: Yeah, and unfortunately sometimes that can become chronic too. If it has become chronic, that’s even more reason to deal with it because again, anything that’s chronic is also a chronic stressor on the body and you probably have kind of pushed yourself even further into HPA axis dysregulation at that point too.

Laura: But again, it’s one of those things that you want to not ignore the stress side of things when you’re trying to heal from Lyme Disease.

And speaking of just general health issues that can affect your HPA axis, one of the other interesting things that they’ve shown in research to affect your cortisol production is either chronic pain or surgery. If you have a injury that you’ve been having chronic pain with, if you have a surgery where there’s a lot of inflammation because that’s just the nature if there’s a major surgery you need to have inflammation to help heal, that in itself can potentially cause HPA axis issues.

Kelsey: Right.

Laura: You can’t always avoid it, like if you were in an accident or something like that and you need to get surgery to repair it, we’re not saying don’t get surgery. We’re just saying if you have to go through surgery, don’t just try to power through it and then just go back to some stressful lifestyle. Make sure you take the rest that you need.

Kelsey: Right.

Laura: Because do recognize that it is a pretty significant stressor on the body to get surgery. Especially if the surgery is a result of some kind of accident or traumatic event, that event in and of itself is one of those severe acute stressors that we were talking about last time.

Kelsey: Which ironically, the severe acute stressor if it’s not followed by chronic stress afterwards, it’s actually less of a problem than the low level chronic stress.

Laura: Right.

Kelsey: That was interesting when I was doing this research on autoimmune disease. They actually found that the chronic daily minor stressors that everyone deals with every day actually had more of a relation to disease risk and progression than the major traumatic life events. Just really interesting, you would think going through a major event would make it worse, but sometimes it’s actually those daily stressors that re just are completely unmanaged and they just happen every day that actually cause that chronic high cortisol, which leads to the cortisol resistance, which leads to all those issues we’ve been talking about.

Laura: Right.

Kelsey: If you think about how our ancestors would have had stress in their lives, it was definitely more acute too. It was like something big happened like they’re being chased or something and that sets off the stress response, but then they relax and recover after. So as long as our stress kind of looks like that where if there is some significant acute stressor, as long as it happens and then we give ourselves to recover, rest, all that, we’re kind of meant to deal with things that way actually.

Laura: Yeah.

Kelsey: With surgery, that’s exactly what that is. It’s an acute stressor, but as long as you really give yourself the opportunity to recover from that, it should be completely fine. The reason why surgery can be problematic is because it is a significant source of inflammation and it stimulates the immune system because the body is kind of dealing with things and bacteria that probably wasn’t there before. If you don’t give yourself that opportunity to rest and recover, that can turn into a chronic stimulation of the HPA axis with that inflammation and that immune activation as well.

Laura: Mm hmm.

Kelsey: With chronic pain, obviously it has the word chronic in there so you know that this is something that the body is dealing probably on a daily basis and it’s activating the HPA axis every time that you are in pain because of course that’s a stressor. I think we can all probably understand that. As we’ve talked about a million times in these podcasts, the longer something like that goes on, the more dysregulated the HPA axis becomes overtime.

Laura: You know what’s crazy, is I think I remember reading recently the chronic pain could also be related to chronically poor posture. If you‘re posture is bad, that that can actually raise cortisol.

Kelsey: Interesting.

Laura: As I’m sitting here like hunched over my computer talking into the microphone just thinking about that. If you kind of constantly have this poor posture where you’re not sitting upright, or even I think sitting too much, but if you’re hunched over and that can potentially cause some chronic pain issues if you’re not getting good alignment in your back and that kind of thing.

Kelsey: Mm hmm.

Laura: But even just the act of having poor posture can activate your HPA axis.

Kelsey: Wow.

Laura: It goes deep, really does lot of stuff.

Kelsey: Apparently.

Laura: The more Kelsey and I study this stuff, I know for myself, I’m just like oh my gosh, I do that wrong, I do that wrong.

Kelsey: I know. It is hard not to get overwhelmed. But don’t get overwhelmed. There’s stuff you can do about these things and nothing going to make or break your HPA axis system. You just need to try to get everything to be as good as possible. Nothing is ever going to be perfect. And we’re meant to deal with some stress, of course, we have to. It’s just a matter of dealing with it.

Laura: It’s kind of funny you think about the kind of stressors people used to be under even just 100 years ago compared to what stresses us out today, and it’s just so different.

Kelsey: It is.

Laura: It’s kind of ridiculous. I don’t think our lives are harder than they were. They’re probably easier in a lot of ways, but the just the kind of weird stuff that we’re exposed to just causes different kinds of issues.

Kelsey: Exactly.

Laura: We’re just trying to address those. That’s why we’re the Ancestral RDs. We want to help you guys get back into a more ancestral way of living so that way you’re not getting all these modern illness from the way that our modern lives affect us.

Kelsey: Right.

Laura: Actually that’s a good segue to our last point about what can affect your risk of HPA axis issues. Negative emotions, that is something that we do have control over. It’s one of those things that we’ve talked a little bit about a lot of things you may not have a ton of control over, but emotions and perception of your life and just living your life in a way that you’re not being pessimistic and looking for the bad things in everything, that can really help prevent some of these issues.

There’s this guy called Dr. Lam who writes a lot about adrenal fatigue. He has this really crazy comprehensive website. It’s almost like overwhelming with the amount of information it has. But he had this list of negative emotions, and we have some of those, and then I also added a few. The ones that we have listed are anger, being angry at people in your life, or being angry at situations, that could be like road rage.

Kelsey: Or even yourself.

Laura: Right. I mentioned road rage as something because I know that’s something I get a little…I’m from New Jersey so sometimes I get a little frustrated with drivers in North Carolina and I could see that as being something if I was commuting a lot I would be exposed to a lot more anger because right now I’m only commuting a tiny bit. But like you said, anger at your own circumstances, or the way other people are treating you, or whatever that anger is. Anger is a pretty strong emotional and that can definitely affect your HPA axis.

The next one is fear and guilt. That’s a tricky one because fear is one of those things there are something’s in our lives that are legitimately, not okay, but normal to be afraid of. Or somebody’s in kind of an abusive relationship and they have a fear a lot, that’s a really unfortunate reason for having a lot of fear.

Kelsey: Right. And we have fear for a reason, obviously.

Laura: Right. Beyond the abusive relationship thing which is also on our list, we have the abusive and toxic relationships as being a source of adrenal fatigue issues. I would say just fear that people that have about things that you shouldn’t be afraid of. Honestly looking at this list, that’s the one that I struggle with a lot is having fear about the future, or fear that I’m not doing what I’m supposed to be doing. I don’t even know, it’s so weird.

Kelsey: I would say even like fear about things that could potentially happen to you or the people you love. We are exposed to so much negative news on a regular basis. There’s another podcast, I’ll have to link to it because it’s an NPR podcast and they talk about this issue where like we’re just exposed to so much negative things that are happening in the world that we’re more fearful because of that even though the amount of these terrible things is probably not different from 50 years ago. It’s just a matter to being more exposed to that it’s happening and that affects us.

Laura: Being more aware of it.

Kelsey: Yeah, exactly.

Laura: Right. Then guilt would be, I mean that’s another super broad type of emotion. I’m trying to think of some typical things. Guilt could be past life events, guilt could be feeling like you’re not doing enough right now for certain people. I know a lot of moms and parents in general, but I feel like this is a big mom thing to feel guilt that you’re not proving your kids the exact life that they deserve, or anything like that. You can really take that pretty far. I have patients that they take their kids to all sorts of sporting events, and after school activities, and that kind of thing and they still have this nagging guilt that they’re not doing enough for their kids. Just because you have the guilt, doesn’t mean it’s actually what’s happening.

Kelsey: Sometimes guilt over taking care of yourself.

Laura: That’s a good one.

Kelsey: That’s huge because especially if you’re dealing with adrenal fatigue, you’re not feeling great and it can fill you with a lot of guilt if you’re taking the time to take care of yourself when you feel like you should be taking care of other people, your children, or your spouse, anybody in your life that you’ve kind of been there for a long time and now maybe the tables have turned a little bit. You need to be taken care of a little bit more by them or by yourself at that point. That can cause a lot of guilt.

Laura: Yeah, that’s something that was coming up with our beta testers for our adrenal fatigue program.

Kelsey: Mm hmm.

Laura: People saying that they feel guilty about taking time off to recover, or sleeping more, or napping, or not doing the activities that they used to do. It’s really tough because that can really keep you in that cycle of adrenal fatigue if you have guilt over trying to do the activities that you know are necessary to heal.

Kelsey: Right.

Laura: That’s something that we try to help people in our program with that. But that’s something that I think also talking to a therapist about would be really helpful because it’s not a good way to live and feeling guilty about taking care of yourself is just asking for exacerbation of the health issues that you’re having.

Kelsey: Exactly.

Laura: It’s tough though. I have a lot of patients that are in that situation and sometimes I don’t even know that to tell them because at some point they have to come to the realization that their health is important enough to prioritize it and to not feel guilty that they’re prioritizing it. It’s a toughy.

Kelsey: It is a toughy.

Laura: But another one we have on our list is unhappiness with life in general. That kind of goes along with another one on our list that says unrewarding work. If you’re in a job that you don’t really like or if you’re in a relationship that’s not really fulfilling for you, if you don’t really have any hobbies that you enjoy. I mean there’s always that personality that’s kind of a little bit more, I’m thinking of like Eeyore from Winnie The Pooh or something where it’s just kind of down. There is some level of choice involved there. If you’re seeing yourself as being a pessimistic person or not being happy with your life circumstances, your options are either learn how to see things more positively, or change the circumstances.

If you don’t like your job, instead of staying in job that you’re unhappy in, maybe looking for a new job that you might potentially enjoy more would be something actually good for your health. Just because these kind of hopeless situations where you’re just punching a clock at a job that you hate, that is really harmful to your body. It’s not just your mental health, it also harms your body. It’s one of those things that we can’t tell you what to do if you have a job that you absolutely need to stick with. Maybe working on your perspective of life and finding ways to either have more gratitude or finding things that you enjoy like hobbies that can make your life a little bit more enjoying is really important.

Kelsey: This brings up a good point which is sometimes with a lot of these mental outlooks that people have, it can be a little bit of catch 22 because HPA axis dysregulation also is a cause of depression and anxiety which causes a lot of these sort of feelings. If you are depressed or if you have anxiety and you feel like that’s kind of causing a lot of these negative emotions that we’re talking about in this list, know that dealing the HPA axis dysregulation that’s a part of the depression and anxiety will help you to recover and will help you to have a better outlook on life.

But it also is partly choice too. I think recognizing that and trying to change your outlook as much possible and see things in a more positive light, the more you do that, the better you’re going to feel and the better your HPA axis dysregulation is going to heal as well.

Laura: Mm hmm.

Kelsey: It is a cycle in that sense too that the more you can do for yourself along with healing from HPA axis dysregulation, the better you’re going to recover in all aspects.

Laura: There’s something to be said if you do have a clinical depression or anxiety disorder, using appropriate medication in that situation could be important. Like you said, if somebody’s clinically depressed, telling them to just snap out of it is not appropriate.

Kelsey: Right.

Laura: Potentially getting on some kind of medication that can be helpful just to get them out of that depressed state and then that’s when they can start having a more objective experience of life and then they can just start actually saying, okay, maybe there is some stuff in my life that I want to change as far as my happiness is concerned.

Kelsey: Interestingly enough, SSRIs and the ways that they treat depression, research is showing now that the reason partly why those work is because it’s affecting the HPA axis, which just goes to show that what we’re doing here, it really makes a difference.

Laura: Yeah and then again, it’s that whole chicken and the egg situation where it’s like well, do we fix the HPA axis first? Or do you have to deal with the cause of it first? It’s kind of a difficult thing to figure out somethimes.

Kelsey: It is.

Laura: Another negative emotion that, this is one on the list that again is an issue for me is either poor self-esteem or self-criticism. If you’re the kind of person that tends to be really hard on yourself or if you just generally just don’t have good self-esteem. My issue is definitely that self-criticism side of things. I tend to be very hard on myself if things are not exactly that way that I think they should be.

Kelsey: I think a lot of people deal with that, absolutely. It’s huge. I see that a lot with my own clients and I’m sure you do too, Laura.

Laura: Oh yeah.

Kelsey: That can really be devastating to someone and really put them in a funk and kind of change their HPA axis negatively too.

Laura: I think the self-esteem thing is even worse. I mean self-criticism, it can be okay if you’re using it as a way to kind of reevaluate your life and make changes.

Kelsey: Right, for the better.

Laura: Right. And not that you want to be super self-critical, but at least if you’re using it as a way to enhance your life and not just kind of wallowing.

Kelsey: Right, and being realistic about the kind of things that you’re being critical of in the first place, it can be useful.

Laura: If you combine that with poor self-esteem, then that’s the really bad situation where not only criticizing yourself and over analyzing your performance, or your appearance, that kind of stuff, but then you’re also coming to the conclusion that either the way you look, or the way that you’re able to do things, or your intelligence, or whatever the issue is, that you’re concluding that it’s not good and that is a seriously big issue when it comes HPA axis issues.

Kelsey: Yeah.

Laura: I see that combination a lot in my patients. I don’t often see someone with adrenal fatigue that just is critical of themselves but does not have bad self-esteem, if that makes sense.

Kelsey: Right, yes. They are very much hand and hand most of the time. I think those kind of feelings can lead to another thing on our list which is orthorexia and perfectionism with health. Because if you don’t feel good about yourself, let’s say you feel like you’re overweight, you tend to be really strict with your diet, which is what orthorexia is if it becomes sort of an eating disorder type of issue, if you’re trying to be so restrictive with your diet that it becomes that way. That just feeds into trying to be perfect with your health, which it can lead to a mental issue where the amount that you’re restricting yourself and the pressure you put on yourself to be perfect in all aspects of health, that is a huge stressor on the body.

Laura: It’s funny because it kind of leads back to what we talked about in the last episode about all these diet and exercise choices where if somebody is becoming orthorexic and is overly obsessed with having “perfect health,” that’s when they start to engage in those sort of behaviors where they’re under-eating, over-exercising, maybe not paying attention to social relationships because they have to go to the gym instead of going out to dinner with their friends or something like that.

Kelsey: Right.

Laura: That is something I see a lot in my clients where they…you know what I see a lot is they got to the point the where they we retrying to lose weight and they were about maybe 10 or 15 pounds away from their goal, and then they started getting really deep into this perfectionism orthorexia type behaviors, and having bad self-esteem, and criticizing their selves a lot, and then they started gaining weight because of the HPA axis effects of all that negative emotions.

Kelsey: Right.

Laura: Then it just becomes another vicious cycle where they don’t know why they’re not losing weight, so then they start to restrict more, exercise more. And it’s just like those are really difficult situations. It’s really hard. We talked to some of our beta testers about this. It’s hard to say okay, I’m going to put aside weight loss for a minute and get my HPA axis fixed.

Kelsey: Exactly.

Laura: A lot of times when their working on fixing the HPA axis, they end up gaining weight because they’re body is in this crazy stress mode and getting out of the stress mode usually requires eating a lot, and not exercising, and that kind of thing.

Kelsey: Right.

Laura: It’s just really tough because it’s like I don’t want people to feel like they have to gain weight to get to the health that they want to get to. But if they’re primary goal is weight loss, a lot of times that can lead to these poor adrenal health decisions and it just becomes completely not effective for the goal that they’ve set and then it just ends up making their health worse in the long run.

Kelsey: Right, right. That’s unfortunate.

Laura: That’s something I know I see it all the time and that was a big motivating factor to create this Paleo Rehab program.

Kelsey: Yep.

Laura: Basically we’re trying to help people get out of that cycle of almost pushing themselves into that adrenal fatigue state because they’re trying to be so healthy.

Kelsey: Exactly.

Laura: Which isn’t everyone, but there’s certainly enough people out there that get into that situation.

Kelsey: Alright. We’ve kind of talked a little bit about abusive and toxic relationships. Is there anything you want to add there, Laura?

Laura: That is something again, that has more to do with external stuff. I mean if you’re in an abusive relationship or if you’re in a relationship that’s causing you an insane amount of stress, the quickest way to say to deal with that is to end the relationship. I know that’s not as simple as I just said.

Kelsey: Right.

Laura: Ultimately that is pretty much the only way that that’s going to be improved. Even if it’s a spouse, if somebody’s being abusive, that should not be something somebody’s putting up with. If you have a friend or a relative that’s taking advantage of you. When I say toxic, it could just be someone that is really negative and is kind of unloading all this negativity on you all the time.

Kelsey: Right. It doesn’t have to be abusive necessarily.

Laura: Right.

Kelsey: There are a lot people that, I like that word, it’s kind of a toxic relationship or a toxic person for you personally just because of the way that they communicate with you usually.

Laura: Yeah or maybe they are very needy and they don’t really reciprocate any of the friendship that you’re proving them. That’s something that can again be really complicated to figure out, but especially if it’s someone like your spouse who you have to live with and there’s a lot of negative emotion involved in that relationship, then either going to some kind of marriage counselor, or again seeing a therapist, or if it’s possible to end the relationship if it’s say like a boyfriend or a friend that you don’t really have to see if you don’t want to, then you have to make those hard decisions to take care of yourself.

Kelsey: Right, yeah. That feeds into the last one I would say here which is fighting with family, friends, or strangers. If it’s a stranger, usually it’s going to be somewhat acute in that sense. Like it just might one time encounter something bad happens and hopefully you can give yourself some recovery time. But sometimes those sort of things are constant.

A lot of times it can come with the territory, like in certain jobs where you’re just interacting with rude strangers a lot, or things like that. If it is chronic in that way, it can be very difficult to change that obviously. But working on your outlook, seeing things more positively, and just thinking about any way that you can try to make the interaction more positive, even if they’re not going to reciprocate, you can feel better about how you handle the situation and that kind of usually puts a more positive spin on it too.

Laura: Yeah one thing I was just thinking of when you say fighting with strangers, the first thing that comes to my mind is internet comment board arguments. Which that always blows my mind when I see that stuff going on because that is like asking for HPA axis issues if you’re the kind of person going around getting into fights with people on comment boards.

If that’s a behavior that you’re engaging in, I would strongly recommend reconsidering the purpose of that. I know people can get really passionate about their beliefs about nutrition, or health, or whatever. It doesn’t have to be health related, it can be anything. I don’t know what people fight about on the internet these days. Any topic you can probably think of, I’m sure there’s a fight in a comment board. Just notice if the kind of interactions you’re having on social media are super negative, then consider doing a social media detox where maybe you get off it for a while and just kind of reevaluating that kind of behavior. Fighting with family and friends, that’s a little bit more obvious that it’s happening and maybe you can talk to the person about improving your relationship or again go to some kind of counselor to help that situation. But if you’re getting involved in these arguments online, the only person you’re hurting is yourself.

Kelsey: Exactly.

Laura: If that’s something you find yourself doing in a regular basis, then I don’t know. I mean just from my own perspective if there would be any sort of criticism on my blog, I would always try to respond to it. I’ve gotten to the point where if it’s something super nasty or if it’s an email if somebody’s just like a vegan that just wants to tell you how you’re an idiot and how eating animals is murder and blah, blah, blah, just deleting it and just pretending like it never happened is so much better for mental health.

Kelsey: It’s not worth the time in terms of your mental health.

Laura: Right. That can go for even if you’re just on Facebook and you have a friend that posts you super insighting posts and you feel oh I have to tell them that they’re wrong, just reconsider how important that is and make sure that you’re not hurting your own health in the aim of correcting someone’s misunderstanding or something like that.

Kelsey: Yes, defianatly. It gets a little bit more complicated when it’s friends and family because obviously you’re exposed to these people a little bit more. Often times especially with family, it can be someone who you’re kind of forced to see more than you probably would like. If that’s the case, again changing your outlook as much as possible, figuring out if there’s anything you personally can do make the interaction a little bit more positive, or just as much as possible avoiding them if that’s all that you can do. If you really just notice there’s truly nothing that seems to change the situation, trying to avoid them as much as possible.

And if you’re close enough with someone, bringing up that there are negative emotions can always be a good thing. I always think honesty is the best policy. You want to communicate with people that you’re going to have to deal with on a regular basis. If you feel like that would be appropriate, potentially if you need to do that with a counselor or something like that, that might be a good choice too.

Laura: Okay. Well, I think that was the longest podcast we’ve ever done.

Kelsey: Yes, this is very long.

Laura: Hopefully people are still listening. I probably should have cut that into two, but maybe you guys can just listen to it on two separate occasions. But hopefully all of that in the last two episodes made sense to you guys. Again, our goal is to kind of give you an idea about all the different things that could potentially cause adrenal fatigue just to make sure that you’re not ignoring something. Like we said, we have a lot of patients that come to us that are trying to figure out what they’re doing wrong in their diet to have these issues. And as you learned in the last two episode, diet is just one factor that could be affecting your adrenal fatigue or your HPA axis function.

Kelsey: Right.

Laura: If you’re eating the “perfect diet,” even if it is literally the perfect diet, even if anyone can ever actually accomplish that, if you have any of these other issues going on like bad relationships, or some kind of underlying health issue that you’re not dealing with, or if you’re staying up super late, any of that stuff can completely derail the progress that your diet would help you make. Hopefully this gives you a really good sense of all the different things that could be the underlying cause.

Just as a quick little plug, we do talk about a lot of this stuff in our adrenal fatigue program. It’s called Paleo Rehab: Adrenal Fatigue. We will link to that in the show notes. That one is what we keep talking about when we say the beta launch participants that we’re working with right now. The program, we’re scheduled to launch at the end of April. I think April 28th is our anticipated launch date.

Kelsey: Yeah.

Laura: Hopefully that will be exactly when it happens and I won’t be eating my words later.

Kelsey: And we’re so excited to have you guys join us with that. If you are at all interested, definitely get on our newsletter list so you can find out when it comes out. Hopefully again, it will be April 28th. That’s the plan. And you’ll also get our free e-book which is awesome. It talks a lot about this stuff and what to do about it as well.

Laura: Yeah, the e-book will give you a couple of hints and tricks on how to start implementing some of the stress management changes that we talk about.

Kelsey: Exactly.

Laura: Hopefully that will help get you in the right path and not make you feel overwhelmed. Anyway, thanks for joining us for these two episodes. Again, if you have any questions about anything, or if you have anything to add to the conversation, say that you have some advice or you’ve gone through something that we talked about and you have some information that you feel would be helpful to our listeners, feel free to share in the comments on our website, which is TheAncestralRDs.com. Otherwise, we’ll look forward to seeing you again in a couple weeks.

Kelsey: Alright. Take care, Laura.

Laura: You too, Kelsey.


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I'm a women's health expert and a registered dietitian (RD) with a passion for helping goal-oriented people fuel their purpose.

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