Episode 44: A Major Update To Our Adrenal Fatigue Program

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Thanks for joining us for episode 44 of The Ancestral RDs podcast. If you want to keep up with our podcasts, subscribe in iTunes and never miss an episode! Remember, please send us your question if you’d like us to answer it on the show!

HPA dysregulation, and dysfunction, and maladaptation, Oh My! What do these terms have to do with adrenal fatigue? Perfect timing for our major update to the Paleo Rehab: Adrenal Fatigue program!

In this episode, we share new insight into this misunderstood health issue and reveal exciting details of our updated program. Advances in testing and our deeper knowledge to interpret the results mean a more effective individualized treatment plan for you.

Don’t miss this one.  It’ll change the way you see your body’s role in adrenal fatigue. It may be the key to unlocking your health!

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

  • Overview of the Paleo Rehab: Adrenal Fatigue program
  • The exciting updates to the program and why we are doing it
  • The limitations of saliva testing
  • The advance in testing that provides more information for us to address the complexity of your adrenal fatigue
  • Why low cortisol may not be as common as once thought
  • Why a one size fits all approach to supplementation is not appropriate, and can even be dangerous
  • Why the three stage model of adrenal fatigue is outdated
  • How the patterns we discovered give additional insight into related health issues
  • Why adrenal fatigue as commonly described is not accurate
  • The stigma of the term “adrenal fatigue”
  • Insight into how the HPA axis is the real contributor to symptoms of adrenal fatigue
  • How the Paleo Rehab: Adrenal Fatigue program can benefit anyone with chronic illness

Links Discussed:


Kelsey: Hi everyone. Welcome to Episode 44 of the Ancestral RDs. I’m Kelsey Marksteiner, and with me as always is Laura Schoenfeld.

Laura: Hi everybody.

Kelsey: How are you doing today, Laura?

Laura: I feel like finally back to normal after being sick for a good week and a half. It’s been kind of frustrating. I don’t get sick very often.  And I kind of think it was my own fault.  I had been staying up watching a little bit too much T.V. about a week earlier.

Kelsey: Oops.

Laura: Yeah. I got a little hooked on Girls.

Kelsey: Oh gosh, so good.

Laura: In hindsight I was like, why am I watching this so much? But it was just kind of like H.B.O. now is doing that auto play thing, which is totally dangerous.

Kelsey: Right. Binge watching at its finest.

Laura: Yeah. It’s like, well, it’s easier to just let it keep going. Anyway, so I feel like I wasn’t getting enough sleep and then I had kind of an extra hard workout.  And we had a little bit of a semi-family  not emergency but like my sister’s husband lost his nephew and it was kind of like a little bit of an upsetting event. And so I feel like all of those things kind of just combined to destroy my immune system.

Kelsey: Right. No kidding.

Laura: I was trying to get over it for I guess it was like a week and a half. I was taking like every single different immune supplement that I had, all these different herbs, and Vitamin A, and zinc and doing this like chaga mushroom tea and everything that I could think of.  And it just really lingered a lot longer than usual, which was kind of frustrating. Normally if I get sick it’s like really intense for a couple days and then it’s over.  And this was like the longest period of time that I’ve been sick for a while. So it was a little frustrating, but I got over it and now I’m back to the normal daily grind.

Kelsey: Yay?

Laura: What about you? I hear you’re out and about.

Kelsey: Yeah, I’m in Massachusetts. I’m staying with my parents because all of the mold situation. So if you guys listen to the last episode, you’ll remember that we found mold in our apartment.  And we’ve been on our apartment for five years, so it really sucks that it’s there and we have to figure out a new living situation. And in the meantime, I am hanging out with my parents, which is super exciting as I’m sure everyone can imagine.  And so I’m in Massachusetts.  And I’m at my dad’s house currently but my mom is remediating her house because she actually found mold in her house too, which is crazy, but I guess makes sense because she’s been dealing with some lingering health issues, too. She has Lyme disease and that’s really tied in with mold exposure, too.  She really hasn’t been able to kick the Lyme disease and now it’s all falling into place in my brain. It’s like, well, I guess if you’ve been exposed to mold for a really long time and you’ve got Lyme disease, your immune system is just totally messed up and no wonder you can’t get rid of the Lyme.  So she’s remediating and I’m moving in with her next week, and we’re going to detox together and hope that we feel better.

Laura: Yeah. I was kind of joking before we got on the call that I think maybe you and your mom need to go take a couple weeks break in maybe Arizona or something where it’s super dry and doesn’t necessarily have the same propensity for mold as you do in the northeast.

Kelsey: Yeah.

Laura: That’s a major bummer though. I mean it almost sounds to me like you’re just always going to be on your toes about where you live and where you’re all spending a decent amount of time, which sounds kind of frustrating.

Kelsey: Yeah. Well on one hand, I’ve been feeling like, well it really sucks just to work at home because then you’re in your home environment literally all the time.  But on the other hand, at least you can control that environment a little bit more.  People who have to work in newer buildings that maybe are experiencing “sick building syndrome” or things like that and they either have to get rid of their job, go get a new job, or just live with it.

Laura: That’s crazy.

Kelsey: I know.

Laura: It makes me wonder how many people are dealing with that that don’t even know, because I feel like this would be a topic that most people are just so oblivious to. I mean I feel like I’m kind of oblivious too, as far as you know a lot more than me.

Kelsey: I was too, prior to all this.

Laura: Are there things that you can do to kind of prevent feeling that way?  I’m thinking of things as stupid as like wearing a dust mask, or getting an air filter that pulls dust out of the air. I mean I’m assuming the mold is in the dust, right?

Kelsey: It is. But basically, if you have mold growing, there’s a reason. So there’s typically some sort of leak or something causing the mold growth. The idea behind remediation is obviously to remove the mold that’s grown there already, but also to find the root cause of what caused the mold in the first place, which like I said is typically a leak.

So I don’t think that just wearing a mask or filtering out the air would completely resolve that without actually cleaning out the mold itself.  But it’s funny because my mom has been staying with my sister in Boston for the last couple weeks while her house is being worked on. When she goes back to her house, she wears this funny little mask to go in the house and she’s not really sure if it actually filters out the mold particles or anything like that. But she’s like, it’s better than nothing.

I don’t really know all that much about it either. But, yeah, I don’t know. It’s unclear to me.  And I just did a deep dive into this stuff very recently, so I wouldn’t say I’m an expert on this by any means. But from my understanding so far, it does really seem like you do need to remediate.  Otherwise, you’re just always going to be exposed to it no matter what, even with air filtering and things like that.

Laura: Now is not something that she has to pay for out of pocket? Or does home insurance cover it? Or what’s the story there? I can imagine if you have a whole wall you have to take out, that can get kind of expensive.

Kelsey: Yeah.  I think she tried to get home insurance to cover it, and I’m actually not sure if it ended up working out or not. I’ll have to ask her. It does get very expensive.

Laura: That would be a really serious issue if you couldn’t afford to do the remediation.

Kelsey: Right.

Laura: You would think if there was water damage, that that’s kind of coverable by home insurance. But I don’t know. Maybe it depends on what kind of insurance you have and if they cover water damage.

Kelsey: Yeah, and I also think that mold is just this kind of enigma that nobody really touches on.  So it’s not this thing that everybody knows about and everybody is on board that it’s bad for you.  I think there are certainly people out there who are just like, well mold is everywhere. You can’t really do anything about it. So it’s not really bothering anybody unless it’s black mold. Everybody can kind of agree the black mold is bad. But if it’s any other kind of mold, it’s really up in the air as to what sort of the general population, and people working in homes and things like that, as to whether they actually think it’s harmful or not.

Laura: Gosh. That’s really annoying.

Kelsey: It is.

Laura: Just hearing about that makes me kind of angry that it’s something that isn’t dealt with, and if somebody has to deal with it themselves, that there is really no precedent for having that covered by homeowners insurance. It’s almost like health insurance where if you have some kind of weird health issue, like I was treated for Lyme a couple years ago and all of my stuff was out of pocket. I think maybe the antibiotics were covered, but the doctor didn’t take health insurance.

Kelsey: Right.

Laura: It’s like there’s all this stuff that can really help people as far as their health is concerned, but because it’s so “alternative” it doesn’t really get covered from a normal health care perspective.

Kelsey: Right.

Kelsey: I wonder if that’s ever going to change. If we’re going to get ten, twenty years down the road and then everyone gets their house tested for mold, and then everyone gets their remediation covered by insurance because it turns out it’s some crazy issue that affects a big percentage of the population.

Kelsey: Right. And I do think there’s been a lot more discussion of sick building syndrome with all these newer buildings going up that are using materials that just get moldy very easily. They’re kind of prone to that.  So I do think it will probably become a bigger issue as time goes on, unfortunately. But that also brings awareness and hopefully change within that system. So we’ll see.

Laura: Now when you say newer, how new is new in your opinion? Is it twenty years old? Is it five years old?

Kelsey: That’s a good question. I know with mold, actually we were talking about this before, older buildings are better.  So think pre-war buildings where they’re using a lot of plaster, less dry wall. So I think basically anything that’s using a lot of dry wall is not great, which is pretty much everything.

Laura: Anything from like the nineteen, I don’t know, seventies and beyond or something.

Kelsey: Right, exactly. And I think another issue with newer buildings is that they’re now using central air, things like that, where they have all this duct work that goes through the building.  And if you have mold somewhere, it just spreads it everywhere.  So that’s another problem.

Laura: You’re making me feel like I should get my house tested.  I’m actually working on buying my house that I live in. I would be so mad if I if I got that test done and I found out that this house that I’m in has mold. I don’t even know what I would do.  I’m in a townhouse and I feel like there’s rules about what you’re allowed to do in a townhouse compared to your own freestanding house. I don’t know if I did buy it if I would be…like I don’t own the roof.

Kelsey: Right.

Laura: What if there’s mold in the roof? What do you even do there? Hmm, things to think about.

Kelsey: I do think that it’s a small percentage of the population that is very sensitive to mold in that sense. I don’t have allergies to mold, but apparently I’m responding to mold.  But that’s a pretty small percentage of people. Most people when they’re exposed to even fairly large amounts of mold, unless it’s something like black mold where again, we’re kind of all aware that that’s a problem, most people will tend to be fine. I mean I still wouldn’t want to live in mold regardless because we don’t totally know that it’s completely safe for everyone or even the people that don’t have this sort of genetic propensity to respond to it.  So even if you did have mold, you may be one of those people that it just doesn’t bother you.

Laura: I hope so.  Otherwise you’ll have to maybe buy this as a rental property instead of living in it myself. That stinks. Well hopefully your mom’s house gets fixed up soon and like I said, if not you guys should just go on vacation somewhere super dry. Actually I don’t even know. I feel like Arizona and New Mexico would be a good choice. But what about Texas or something like that. I feel like down in the southwest it’s a lot drier out there.

Kelsey: Probably would work quite well.

Laura: Might be a reason to go to Austin or something for a little trip.

Kelsey: Yeah, could be fun. Exactly.

Laura: Make it an excuse. Oh, I have mold. I need to go hang out in Sedona at a spa for a couple weeks.

Kelsey: Right. Sounds good to me.

Laura: Well, if you need someone to join you, just let me know. I’m down.

Kelsey: Oh, for sure.  So let’s get into our topic for today. I’m sure everybody’s sick of hearing about me talking about mold.  Although, maybe we should do an episode on mold one of these days and kind of go into it in depth because I’m sure there are a lot of people dealing with it.

But for today, before we jump into our topic, here is a word from our sponsor.

Kelsey: Alright. Today we’re going to be talking about adrenal fatigue. For those of you who have been following us for a while, you’re probably aware that we have a program called Paleo Rehab: Adrenal Fatigue where we basically walk you through figuring out if you have adrenal fatigue and then really changing your diet, lifestyle, and potentially supplementation routine to help you overcome that and help get your HPA axis functioning again.

But we wanted to do an update because we are actually in the midst of updating and revising our program because we’ve found out some new information, and that new information is about testing for adrenal fatigue. And we used to use saliva testing to test for adrenal fatigue. That’s what we recommended in our program and we are revising it to now use a lab that does urine testing. And with urine testing, you just get a lot more information, which can help prevent basically just basing your diagnosis or thoughts about where your H.P.A. axis functioning is right now on one piece of information. You actually get, Laura, is it there’s three different types of information? There’s metabolized cortisol, free cortisol, and then you can also see where your cortisone pattern goes over the course of the day, and your cortisol. Right?

Laura: Yeah. I think you’re going from basically four data points in saliva to probably, I want to say like ten different factors in the DUTCH test. So it’s definitely a lot more information. And on one hand,  that can make it a lot more complicated as we’ve been learning as we’re are doing the edits.  But we felt that first of all, this new test being available, it wasn’t really something being used very much when we were designing the program in the in the beginning. And saliva testing was kind of the gold standard and that’s what everybody was using to identify cortisol dysregulation.  And it kind of went along with the three stage model of adrenal fatigue that most people in the Integrative and Functional Medicine community had come up with.  However, some through digging on our own, and also a lot of the work that we’ve done with Chris Kresser on his practitioner training program, we discovered that there is a lot more complexity to adrenal dysfunction, or HPA axis maladaptation as we might call it.  And we decided that in order to make sure our program was giving the best results possible, that we wanted to make adjustments.

Kelsey: Mm-hmm.

Laura: And I think it’s really important to talk about why we’re even doing these changes, because honestly, we had a lot of really good results with the program. I think most of our participants got really good improvements. Their health improved. Their energy was a lot better.  I’d say the bulk of the program being dealing with diet, and lifestyle, and mindset is the reason for that.  And certainly the original supplementation recommendations were, I don’t want to say inaccurate, but they just weren’t as tailored to the individual as we like to have things.  And so when we found out this new information, and we realized that the original recommendations that we made were not as, I hate to say accurate, but they weren’t as accurate as we wanted them to be. We just felt like we owed it to our participants and our future participants to make sure that the information was as accurate as possible with the understanding that this kind of stuff changes.

Kelsey: Right.

Laura: One of the things that makes functional medical nutrition therapy really interesting, but also really challenging, is thatnew information is coming out all the time. And in my opinion, the best practitioners are going to revise their original recommendations as they learn this new information.  Some people might think that’s wishy-washy. But I would hope that most people would recognize that the ability to change and adapt to recommendations as nutrition science progresses, which is happening all the time, it’s actually a good sign, especially when it comes to either working with a practitioner or doing an online health related program.  I personally really respect those practitioners who are willing to admit that they’ve been either wrong or they misunderstood something in the past because you know that they’re not going to hold on to outdated information just to save face, which I think actually happens a lot.

And I’m just being honest here, it’s a little scary to have to kind of be like, we’re making changes and we’re updating the program to fix some things that aren’t totally accurate. But I’m hoping that most people will see this as, oh, that’s awesome that they’re updating as things change. Because for me, it just seems like if you pick one thing that you believe with nutrition or health, no matter what it is, it’s almost guaranteed that there’s going to be something new that comes out that you’ll either have to make adjustments or totally change. It’s not super fun to have to go back and fix the program because it’s a lot of work. But I feel really good about what we’re doing and I feel like hopefully at least the next year, we’ll see what happens in two thousand and seventeen with H.P.A. axis dysregulation, but I feel like we’re really making some changes that are I think just going to optimize the program. And the testing and the supplements, they are only a small part, honestly, of the whole program. And I feel like the other recommendations we made in the program are still really good.

Kelsey: Yes.  And I say with the lab testing too, it’s more that the way that we tested before, and the way that everybody was testing prior to this this lab coming out with a new way of testing, that’s just the way it was done. We didn’t have the other information. So like you said, these things are always changing. We’re always coming up with new technology that allows us to get more information. And what we determined once we started looking into this new lab was that just looking at free cortisol, which is what saliva testing looks at, is a very narrow way of looking at HPA access function. And with urine testing, you just get this much wider picture of what’s going on, and that just allows you to be very, very specific with the nutrients and types of supplements that you’re using to really specifically alter what you want to alter.

And the general supplementation and the general nutrients that are going to help anybody with any pattern of HPA axis dysfunction don’t change at all because it’s really just supporting the adrenals. And at the end of the day, I mean that’s going to be the biggest help, is to just support the adrenals via a healthy diet, via your lifestyle, and via basic nutrient supplementation that is very important for adrenal health.

The other supplements we’re talking about here that are affected by this new way of testing, because we have more specific information, are things like licorice, and licorice specifically helps to basically extend the life of cortisol, or active cortisol in the body. So you only want to do that, obviously, in very specific situations where we know that cortisol is low, and we know that your overall output of cortisol and cortisol metabolites is low as well.  And that’s what this newer testing gives us insight into, which we didn’t have before.

Laura: Yeah. I would say a good analogy is cholesterol testing and how LDL levels used to be kind of, that’s the bad cholesterol, and knowing what your LDL was was a predictor of what your heart disease risk was. And then you get all the advanced testing like the NMR profile and LDL particle number and particle size, that kind of thing.  It’s not like LDL in itself is a completely useless indicator, and same thing with the saliva panel, it’s not like the saliva panel is totally useless.  But we figure if you’re going to spend money on testing and you’re going to take supplements that are based on your particular cortisol function, then you might as well go for the test that’s going to give you as much information as possible and will prevent you from using anything that could actually cause things to be worse.

I’ve had patients before that had a doctor dosing them with Hydrocortisone, which is basically just prescription cortisol replacement. And that was based on a saliva panel, which you would think if you see a saliva panel that shows low cortisol that, oh, replacing cortisol, that should help. And that’s not something we ever did in our program. We do not do hormone replacement in our program. That’s just not appropriate for a group program.  But even when you’re working one on one with someone, if this doctor was using a saliva panel to dose Hydrocortisone, then hypothetically, the person might not have low cortisol output and giving them Hydrocortisone could actually make the problem worse.

Kelsey: Right.

Laura: And I’ve had clients that actually felt worse taking Hydrocortisone despite having low free cortisol in their saliva. So I think it makes a lot of sense when you see how much more complex hormonal issues can be. Our general strategy with our program is to first do no harm. It’s kind of like, well the diet, and the lifestyle, and the sleep, and stress management, and mindset stuff, all that’s going to be beneficial for everyone that goes through the program, really can’t screw that up. It’s like more sleep is going to make you feel worse, no, probably not.  But with the supplementation, we’re basically at the point where we don’t think anyone should be taking adrenal supplements unless they’ve gotten this DUTCH test done.

Kelsey: Yeah, and that’s outside of those general supplements.

Laura: Right. I guess I meant more like, you go to Whole Foods and there is an adrenal support supplement that you get off the shelf. Or you order something on Amazon that’s like adrenal complex. And not that there is something specifically wrong with those products, we use some of those products in our program. But a good example is someone that has low free cortisol but they have elevated free cortisone, and then they take a supplement that has licorice in it, and you’re basically just pushing more cortisol into cortisone, or something like that. It can get pretty complicated and unfortunately, I’ve heard people say before that, oh, I feel like my cortisol is really high. Like I can just feel it pulsing through my veins. And I’m like, you probably have some kind of stress hormone that you’re producing. I doubt that you know whether it’s cortisol verses adrenaline.

Kelsey: Right.

Laura: So knowing that your cortisol is high, there’s really no way to know, and things can change. I mean if you feel like your cortisol feels really high because you’re stressed all the time, that doesn’t mean that it is. It could be low, and then if you’re taking something that makes your cortisol lower, then you’re going to just feel worse. That’s why I’d rather someone not take an adrenal support supplement at all. And when I talk about adrenal support, I mean like certain adaptogens, and glandulars, and licorice, and that kind of stuff.  I’d rather them not take that at all than take one that is not well matched to their actual cortisol situation.

Kelsey:  Right.  Yeah, and it’s funny because we’ve been working on this, obviously, for the last couple months and we were just recently coming up with the different patterns that we see when we get these lab tests back. And I think we came up with six different general patterns, which is so different from that three stage model that you typically hear about with adrenal fatigue.  And even within those patterns, there are probably patterns within the patterns. This also gives you insight into whether you may have inflammation going rampant through your body, or if maybe your blood sugar is not doing so great. You might have high or low blood sugar.  So it gives you a lot of this other insight that you don’t get from that saliva panel. And it’s just funny because we were looking through this coming up with the different supplement recommendations for each of these patterns, and it took us a long time just because they’re so different.

Laura: Yeah.  And there’s a lot of different reasons things could be what they are. So we have a pattern that could be caused by hypothyroidism, and then the question is, is that hypothyroidism because of iodine deficiency? Is that hypothyroidism because of Hashimoto’s?  So we kind of had to make an assumption that let’s just say it’s Hashimoto’s and make sure that they’re not taking any supplements that would cause an autoimmune exacerbation.

Kelsey: Right.

Laura: It can turn into a rabbit hole.  Like I said earlier, our goal was to make it do no harm first.  Hypothetically, if somebody takes a supplement that we’ve recommended based on their pattern of cortisol results, I’d say the worst, I would hope based on how much research we did and how much effort we put into it, that the worst thing that would happen is that nothing happens.

Laura: That’s always our goal. We don’t want anything negative to happen.

Kelsey: Right.

Laura; And that’s why we always say the supplements are optional, the testing is optional, because if somebody doesn’t want to take supplements, I don’t think that that’s even the main part of the program.  But making sure that even if somebody has high cortisol, we don’t want them to take any adaptogens that could potentially exacerbate an underlying autoimmune condition.

There’s a certain pattern that is associated with obesity or inflammation. So for that pattern, we use some supplements that could help with that.  Not specifically help with obesity.  We haven’t discovered any obesity cures while doing this.

Kelsey: Magic bullet.

Laura: Yea. But we were looking into, ok, why is that found in obesity and what’s the proposed mechanism that obesity causes this pattern? And what compounds effect that mechanism? It was definitely challenging, but it was really interesting to see all the different things that can happen with cortisol, and cortisone, and the metabolites, and all that.  And so turning that into a program that the average non-medical professional can understand, I think that’s something that you and I tend to, I don’t want to say specialize in, but it’s kind of one of our passions, is making this information  digestible for the average person that has some level of awareness of health issues.

It’s definitely been challenging, but I think it’s a good challenge. I’m glad that we’re doing it.  And I think the program is going to end up being even better than it was when we first launched it last year.

Kelsey: Oh, absolutely. And I think I think the cool thing about this new lab testing like we were talking about, it gets confusing and it can become a rabbit hole because there are so many different things that can cause these sort of patterns. Like Laura was mentioning Hashimoto’s, or obesity, inflammation, low blood sugar, high blood sugar, any of those things.  But we also want to make you aware that if you have one of those patterns that that could be the underlying cause. It may not be that you’re completely stressed out all the time and that’s the cause. Even though, of course getting your sleep under control, and doing stress management, all those things are going to help you recover.  But really, the true underlying issue may be that you are obese or that something else is causing rampant inflammation that you need to take care of.

So we also want to make you aware that if there is something that could potentially be causing that pattern, that you seek help for it.  Because a lot of times, a doctor is not necessarily going to pick up on that. Obviously, if you’re overweight or something, you’re going to know that and probably be working on it. But sometimes you can have inflammation that doesn’t get picked up anywhere, and this could be the place that it gets picked up.  And then you can realize what’s going on and kind of dive deeper into it and figure out the issue.

Laura: Yeah, and it’s obviously outside the scope of our program to help people get that kind of testing done or interpret that kind of additional input. But we’re hoping that at a minimum, if somebody gets their results back and realizes that, oh look, I have this pattern that could suggest hypothyroidism. Maybe we’ll recommend some testing to get done, and maybe this person needs to take thyroid medication, and maybe that’s something that would help them feel better.

Again, we’re not going to be like, here’s all the medications you should take, and here’s your diagnosis based on this one little test. But if somebody realizes that that could be an issue, then they’re empowered to go talk to their doctor or whatever health care practitioner they’re working with about the test results, and say hey, I think this could indicate that I have hypothyroidism. Maybe we should do a little digging into that.

Kelsey: Right.  And if they have never gotten a thyroid panel or a full thyroid panel before, this is a perfect opportunity to talk to their doctor about doing that.

Laura: It’s one of those things that, again the diet and lifestyle stuff that we recommend in the program, we feel very confident that that’s going to improve people’s stress response and make sure that there is no extra things affecting cortisol production that can be controlled by these changes. Obviously, things like sleep or circadian rhythm entrainment, and that kind of thing, all of that does play a role in cortisol output, so we don’t want you to ignore that. We want that to be a big focus as far as the lifestyle changes are concerned.

Also with the blood sugar issues, I mean we’ve designed our diet recommendations to try to make the average person have good blood sugar control with the understanding that different people will have different carb tolerance, and giving some flexibility there. But a lot of times with the blood sugar issues, it’s because people are eating not enough, or not eating enough protein, or whatever that  nutrient deficiency is that’s causing them to have hypoglycemic episodes. Or maybe they’re having too many carbs for their personal needs and they’re having high blood sugar. So with the diet and lifestyle changes, a lot of those can help with some of the issues that might be leading to the cortisol dysfunction.

But there’s always a point where there’s people that need to go further, and we’re hoping that the new recommendations will give people some guidance as far as what the next steps are once they find a practitioner that they feel comfortable working with.

Kelsey: Right. And at least for me, I feel like the more research we’ve done into this new testing,  the more convinced I am that testing is super, super important.  Because you’ll see a lot of places that will just kind of list out the symptoms of usually low cortisol, and many people who are dealing with any sort of ongoing illness or anything are going to have a lot of those symptoms. So it can be very easy to just assume that you have low cortisol.  But I do think that looking at this research and  looking at these lab tests and patterns that are coming out, I’m not sure low cortisol across the board is as common as is usually thought.

Laura: Yeah. I think the guy that created this DUTCH test, I’m pretty sure in the research I was looking at…I think it was some major percentage, more than fifty percent of people that had low saliva free cortisol did not have an issue with cortisol production.

Kelsey: Right.

Laura: In other words, there’s probably only thirty percent of people that come up with a low cortisol reading for their saliva panel that would actually benefit from increasing cortisol using supplementation.

Kelsey: Right.

Laura: I think that was a big realization for me, is that it’s not just a small percentage of people that the DUTCH test shows differences for. It’s not like, oh well, most people can really get all the information they need from the saliva panel. And then there’s like ten percent of people that really need more information.  I feel like, really everyone should get the extra information. And you might have like a fifty-fifty chance of the low cortisol on the saliva panel actually being accurate. I’m throwing out numbers. I’m totally making these up. I don’t know the exact percentages, but I know it’s a lot more than just a small percentage.

Kelsey: Yeah.  Just to give an example, I tested my cortisol with a saliva panel probably like four years ago, maybe.  And I think I had one or two instances of low cortisol in the saliva panel, which is your free cortisol.  And then late last year, I did a DUTCH test, which is the test we’re talking about here. And given that there are of course many years between those two tests, it was very interesting to look at the difference because what I found was that my free cortisol looked at least sort of similar to when I had it tested before, where I had one instance of I think it was like borderline low in the afternoon, but then my morning levels were again borderline high. I kind of went from high to low over the course of the day, which is sort of how my free cortisol in the saliva looked a few years ago.

But on the other hand, when I did this DUTCH test, what I found was that my metabolized cortisol, meaning my general cortisol output was on the higher end of normal. So I have absolutely no problem producing cortisol, which is what I would have thought just looking at that saliva pattern from a few years ago because I had I think it was at least one low level, maybe two, and they weren’t super low.  But they were below the normal level, for sure they weren’t even borderline.  So I would have assumed based on that that I was having trouble producing cortisol.  Now I can’t know for sure because I didn’t do a DUTCH test at that point, so things could have changed in these past few years.  But it’s just interesting to think about that because you can have a pattern show up like that, but then have perfectly normal and potentially even high cortisol output, meaning that you have no problem creating the cortisol. It’s just that free pattern that’s a little bit messed up throughout the day.

Laura: Yeah. I think that’s a really good example of how the saliva test will show the same, or very similar free cortisol pattern.  But the underlying information is just so much different as far as what the next steps are, what the treatment protocol would be.

Kelsey: Right.

Laura: And it’s funny. I feel like as we’ve been doing this research, obviously there’s a lot of controversy about whether or not adrenal fatigue is a real thing.  We’ve had our own experiences of criticism from other people, either just random internet critics or actual medical professionals that disagree, which I’m all down for disagreement. I’m happy to have discussions about what is accurate in nutrition and medical information.

However, what I will say is that the research we’ve been doing, for me, further solidifies the belief that, no, adrenal fatigue as is usually described by the internet, or a lot of certain health related blogs, and that kind of stuff, is not accurate. It’s not that your adrenal glands can’t produce cortisol, or that even at this point that they are not producing cortisol. Because as we said before, a lot of times your adrenal glands are functioning perfectly fine, and focusing on trying to fix your actual adrenal glands themselves is really not helping, or even looking at it that way is not helpful.  So we’ve basically just further confirmed the theory that a lot of these symptoms are more of a HPA axis maladapation.

Kelsey: Right.

Laura:  That’s going beyond dysfunction, because when we say dysfunction, that would suggest that it’s pathological, or it’s not normal the way that it’s working, or it’s not working the way that our bodies have been designed to work.  What’s actually true, when you’re looking at what’s causing the stuff, is that the body is working really, really hard to maintain homeostasis and to keep you alive basically, or keep you right trying to keep you functional.

Kelsey: Right, trying to protect you.

Laura: Even calling it dysfunction, you’re kind of saying, oh the body’s not doing what it’s supposed to do.  Actually, the body is doing what it’s supposed to do. But the input that it’s getting from the environment, whether that’s your diet, your lifestyle, any sort of chronic conditions going on, that input into your hypothalamus, which is your part of your brain that controls hormonal output, that is causing the HPA axis to maladapt. So it’s adapting to inputs the way that it was designed to, but that maladaptation is causing those symptoms.

Kelsey: Right.

Laura: And I think that’s really important to remember when we’re talking about “adrenal fatigue.”  Kelsey and I have talked about adrenal fatigue as a term for a while, and I’m still on the fence about it because I understand that it’s a stupid term and it’s really not appropriate or accurate.  And using that term can cause a bit of….

Kelsey: Just confusion.

Laura: Yeah, confusion or a break in the dialogue. You say the word adrenal fatigue to your doctor and they’re just like, oh one of these people again? Okay.

And I get it. I get if you’re using a term that’s not accurate or not a medical diagnosis then it calls into question your understanding of what’s going on. I would love to change the title of the program to HPA axis maladaptation instead of adrenal fatigue. However, I don’t really think most people are searching the term HPA axis maladaptation.

Kelsey: Right. And the people that need this program wouldn’t find it, unfortunately.

Laura: Right. So we’re not changing the name, even though we acknowledge that the term adrenal fatigue is not correct. The good news is one of the first things people learn in the program is that this is why adrenal fatigue isn’t the right term.

Kelsey: Right.

Laura: It’s been interesting to learn more information, and like I said, I don’t think any of it made me feel like HPA axis dysfunction, or whatever you want to call it, is not real. Which I think a lot of people in the conventional medical field would say, oh that’s not something you should be looking at, or treating, or whatever.  I definitely think it’s a really important thing to support while anyone’s healing from any sort of chronic condition, or if that is the major chronic condition, obviously it can make a big difference to deal with it.

But being medically literate, and making sure you realize what’s actually going on, and not thinking of it as an adrenal issue, almost more thinking of it as a hypothalamic issue, I think will kind of help drive home the points that we make about how the diet and lifestyle factors affect what your hypothalamus is doing.

Kelsey: Right. And like you said, this newer lab testing really just confirmed that even more for us that this is something that we really thought of as more of a signaling issue going on in the body versus a problem with the actual adrenal gland, because it’s one hundred percent not.  And that’s of course the unfortunate term that most people are using to talk about this stuff.

If you’re someone out there listening who wants to talk to your doctor about this, and maybe you have more of a conventional doctor, probably best to use the phrase HPA axis dysregulation, dysfunction, maladaptation. They’re still going to look at you like you have two heads because they probably are not up to date on this sort of research.  So that’s one thing to consider. But at least they would potentially and hopefully not just write you off completely when you use a phrase like adrenal fatigue. It’s a misnomer, of course, for what’s actually going on, but also I think at this point unfortunately has that connotation of being something that’s not real. And while that’s not true, because when we say adrenal fatigue we’re really talking about HPA axis dysregulation or dysfunction, and that is all over the medical literature, you just have to remember that your doctor is going to pretty much automatically think adrenal fatigue is not real when you’re using that term.

Laura: It’s always funny. I always come back to this example that if you went into your doctor and said you were having heartburn, they wouldn’t look at you like you’re just missing a part of your brain.  But if you think about what heartburn is, your heart is not involved in it at all.

Kelsey: And it’s not burning.

Laura: Yeah. Well actually, I guess there’s some burning happening, if you’re talking about the acid in your esophagus.

Kelsey: Right. But not your heart, thankfully.

Laura: The heart is not involved in that process whatsoever. I feel like it’s a good analogy. But with the heartburn comment, I almost feel like because heartburn is such an established part of our vernacular, that people are willing to overlook the medical or physiological inaccuracy of the term.

Kelsey: Right.

Laura: Because that’s just what people call reflux or GERD. It frustrates me because I feel like people get so wrapped up in the terminology that they’re willing to deny a condition’s existence simply because the name that it’s been given is, like I said, physiologically inaccurate. Which if that was the case, something like heartburn, you’d see a bunch of doctors up in arms about patients coming in. Oh, he says that he has heartburn. He’s so dumb that he thinks that his heart is on fire. It’s like, okay, let’s….

Kelsey: Take a step back here.

Laura: Yeah. And I think it’s really discouraging to patients who are dealing with these symptoms and really do have an issue going on who are told that it’s just in their head, or that they’re making it up, and they just read a stupid blog that was putting ideas in their heads. I don’t know when the controversy is going to get settled. Like I said, last year there was a handful of times where at least I was embroiled in some pretty significant Facebook criticism, and even directed at other people that used the term in blog posts that either guest posts or interviews with one of us. But it’s just like, oh my gosh, get over it.

Kelsey: It’s honestly a silly argument. I get it. But at the end of the day, that’s harmful to patients, I think, because then they’re not getting the care that they need for a condition that one hundred percent exists. It’s just not an accurate term for what’s actually happening.

Laura: I would say it’s not super well understood.

Kelsey: Right.

Laura: And to be fair, I think the arguments made about the saliva panels not being accurate, like I said, I don’t know if it’s an accuracy issue. I think it’s more of a lack of adequate information issue when it comes to the saliva testing.

Kelsey: Right.

Laura: Because they do use saliva testing and research to show how different inputs change free cortisol output. But as far as using the information to come up with a treatment plan for a patient, I agree with some of the critics that the saliva panel is not good enough to be used.

Kelsey: Right.

Laura: I’m hoping maybe as this new test becomes more widely used, maybe those critics that were anti anything adrenal fatigue might change their philosophy. Or they might see, oh well all of this information actually does allow me to create some kind of treatment plan.

I don’t know. We’ll see what happens. I feel like we’re defending this because both of us have dealt with issues related to our HPA axis, and we work with clients that have issues, and we’ve seen really good improvements in people’s health from addressing stress related health issues or addressing cortisol dysfunctions. I’m willing to take some level of criticism if we need to to get this message out there to people.

Kelsey: Yeah, because it’s important. Honestly, I really do feel passionate about this because it really is not fun to feel fatigued all the time, or to feel like your immune system just can’t keep up with things. And of course there are other reasons that that could be the case, but a lot of times these patients are left doing nothing because they’ve ruled out anything really significant medical wise. They’ve gone to their doctor.  Maybe they’ve been told they have chronic fatigue syndrome or something where they can’t really necessarily do anything about it other than just deal with it.  So this gives someone the ability to take a look at their HPA axis function, see what’s going on and actually improve it. And I feel like the more that we can get people to pay attention to this, the more options we give someone who has just been told there’s nothing wrong with you, but they still don’t feel well.  To me that’s so important.  And I want to be able to offer that to people.

Laura: Yeah, and it’s not like were saying we’re going to cure chronic fatigue syndrome.

Kelsey: Right.

Laura: We’re not making any of that kind of claim. But we are saying that here’s all the different things that could be affecting these symptoms, or I shouldn’t say all of them because like we’ve said before, it’s always new information. I’m sure there’s things that we don’t know about that could be affecting, like maybe mold.

Kelsey: Right.

Laura: That’s something we don’t cover in the program. But that could be something causing some of the symptoms. So maybe you get a pattern back that we say this could be caused by really bad inflammation. And then maybe there’s some different things causing information, like mold exposure or something.

Kelsey: Right.

Laura: It gives people a path to determining the root cause as opposed to, like you said, just kind of coming up on a dead end and saying well, there’s no drug for it so I’m basically screwed and this how I’m going to live the rest of my life.

Kelsey: Right. Yeah. I think that’s really important and I would highly encourage anybody who is listening who has been told that there is nothing wrong with them, but they still don’t feel well, this is at least something to look at.  And like Laura was just saying, it may not be the end all be all for you. There may be something further that you should look into that may come up on one of these patterns when you do this sort of testing.  But even for anybody who’s dealing with any sort of chronic illness,  even if you don’t have cortisol issues or HPA axis dysregulation, implementing the diet, lifestyle, and even general supplementation that we outline in the program is going to be extremely helpful for you.  Because just thinking of one thing off the top of my head, stress management is huge when you’re dealing with a chronic illness.  And that’s something we focus on really, really heavily in the program.

Laura: Well his big update for the program, just so people are aware, is going to be happening in the next couple weeks. I think after this podcast publishes, we’re going to be in the throes of getting our next major launch happening. We’re working with Chris Kresser, actually, to relaunch the program. He’s going to be offering some really great add-on bonuses as part of the sign up for whoever signs up this time around for the new program.  If you already are a member of the program, you will be getting the updates that we’re making. So don’t worry that you’re going to have to repurchase the program for new information. But anyone who buys the program this time around as far as the launch is concerned is going to have access to some really cool bonuses that Chris is putting together for us.

The best way to stay on top of that is to join our mailing list, or to be on Chris Kresser’s mailing list.  I would imagine a lot of you listening out there are probably members of Chris’s mailing list, but if you’re not, you might want to jump on there so you get early notification about those awesome bonuses that he’s providing.  If you’re on our list, then we’re going to share the same information. If you’re not on either list, then you can go to MyPaleoRehab.com and make sure you’re on our list, so that way you’ll get the information once it’s available mid March.

Chris is doing webinar that is T.B.D. as far as the time.  You’ll hear more about that through these emails. But he’s going to do a really awesome, informative webinar and we’d love to have you guys  listen in on that to learn even more about this topic.

Kelsey: We’re very excited, so we hope to see you around in the program, hopefully.  And make sure you’re on our list. You’ll also get an e-book if you are on our list at MyPaleoRehab.com. So if you haven’t gotten that yet, probably being on both our list and Chris’ list is a good idea. But on ours you’ll get a nice e-book about “adrenal fatigue,” or really HPA axis dysfunction, or maladaptation, whatever you want to call it.  You’ll get some great information to get you started so you can start thinking about it.

Laura: Keep an eye on your email for all these updates. We’re happy to have you here.  Feel free to post any questions about this topic in the comments section of this podcast episode.  Just go to TheAncestralRDs.com to do that.

And we just launched, I guess in the last two weeks, a Facebook group that you can join if you want to be part of the discussion about these episodes.  It is The Ancestral RDs Community. So if you want to search that in Facebook, it’s technically a closed group, and the only reason why we made it closed is because we want people to have some level of privacy.  So if they’re posting any sort of health information in there, we don’t want their friends and family to see the questions that they’re posting. You do need to request an invitation, but we are basically allowing everyone in. It’s a pretty open, closed group I would say.  But we just wanted to have some privacy so that people felt comfortable sharing more about their health. That way if you want to share any questions that you have to have us answer on the podcast, or if you want to discuss what we’ve talked about on any episode, just jump in there and you can ask us, you can ask other people. There is a bunch of people that are ancestral health geeks and it’s a great place to discuss the topics that we cover. We’re hoping we’ll see you there.  And if not, then maybe we’ll see you on our e-mail list and you’ll get all the information about our relaunch of Paleo Rehab.

Kelsey: Alright. Well, you take care, Laura.

Laura: You too, Kelsey.


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