Andrew: Today. Now, for our listeners, for our audience, we delved into Beth’s clinical history last time, so we’ll leave that for you to delve into that podcast. It was measuring gut health markers. So, you can look that up previously. But today, let’s get straight down to business space. We’re talking about stress. So, take us through a normal stress response. How do we segment it? What stages are there?

Beth: Yeah. So, I just thought or I just remind everybody that it was over 70 years ago that Hans Selye developed his theory of general adaptation syndrome, which is a stress model that explains the body’s physiological response to stress. Now, these stress responses are divided into three stages, which is alarm, resistance, and exhaustion. So, during the initial phase, the body’s reaction to stress or alarm is the fight or flight mechanism which is triggered in order to prepare the body for physical activity, allowing it to defend itself against potential threat, you know, the tiger is coming. Of course, now that’s a whole lot different. We don’t have tigers, we just have deadlines, we have family stress, we have work stresses, COVID stresses. There’s, you know, always a new virus around the corner. So, the body reacts with this fight or flight response and activates the sympathetic nervous system and releases your adrenaline, noradrenaline, and cortisol. So, that’s all well and good.

Then the second stage of the body’s stress response is when the lowering level of stress due to the body’s allocation of energy to damaged tissue, and as a result, the stress is minimized and the body manages a bit better. Parasympathetic nervous system returns many of the normal functions to normal levels and the body focuses its resources against the stressor, you know, or the perceived stressor. You got to remember blood glucose levels are affected, so they remain high and cortisol and adrenaline continue to circulate at elevated levels, but outwardly, you know, would appear normal. Obviously, there’s an increase in heart rate, blood pressure, and breathing, and this is usually not correct breathing. So, people often shallow breathe when they’re like this, and, of course, that perpetuates more stress, you know, to the body. So, basically, the body is still on red alert. It’s still the meerkat in the…not in the headlights because meerkats don’t see headlights. It’s the rabbit in the headlights still.

And then finally, in the exhaustion phase, the body goes, “I’m over this. I can’t be doing this anymore. I’m depleted of energy.” And if the cause of stress is not resolved, you know, which often in our modern world it’s just an ongoing saga, health issues then can occur, which we may, you know, see as well and not directly relate them to stress, but always gotta take histories of people. I mean, Selye commented, I’ll just have to read this, “Stress, in addition to being itself, is also the cause of itself and the result of itself.” So, I thought that’s pretty heavy hands. Forrest Gump might have just said, “Stupid stress is stress does,” you know.

However, even the American Institute of Stress, there is an institute of stress, God love the Americans, concede of what most of what Selye believed is not entirely correct. And then, of course, for those who are old enough to remember in the 2000s, Dr. James Wilson, a naturopath and chiropractor from America brought out a book called “Adrenal Fatigue for the 21st Century.” And basically, that became our gospel. That became the textbook of, you know, tired people. And even I, as a relatively new person to practice, you know, that’s what I looked.

And the book has a long list of symptoms. That make sense to you when you have these patients coming in, complaining of all those symptoms. So, he was really kind of Google before Google. You could actually Google, you know, Dr. Wilson, your symptoms, and go, “Adrenal fatigue.”

And as I said, most of the patients that I see, and I would say that’s a general population could tick a lot of those boxes, you know. But what we need to remember is the adrenal fatigue, Monica, is actually absent for most peer-reviewed literature and is not recognized by the endocrinology society who claim there is no hard evidence of its existence. So, I think we definitely need to be mindful of this to be considered, you know, credible practitioners that we might need to change the word, you know. Because the original three-stage model defined the progression of stress as adrenal stress, adrenal fatigue, adrenal exhaustion. Yeah. I think we need to update that stage of…I’m gonna call it HPA dysfunction. And so this three-stage model has become a common way of us to explain the progression of the HPA dysfunctional maladaption to stress, really, using cortisol and DHEA values, okay?

So, some of these labs doing the test will categorize your patient into a particular stage based on their test results. You need to be mindful that this is computer-driven spit out, the reporting. It is not specifically relevant to your client. That is what you as a practitioner will need to then determine from the results and the symptoms in how that relates to your client. So, you just need to be mindful of that. They haven’t gone, “Oh, well, Jenny Smith and her results. This is what’s going on with Jenny.” It’s a very generalized comment to those results. Yeah. That make sense to you?

Andrew: Yeah. Yeah. No, of course, Jenny Smith is not by fun any person living or dead.

Beth: Correct. Correct. And her name will be changed for purposes. Yeah. Now, I’m not suggesting we abandon all the stages altogether. I just think we need to look at them as common patterns of point of reference, not as rules. Yeah. So, we cannot fit a patient’s cortisol result into a neat box and go arrive at immediate conclusion, you know, this equals that because you need to use your diagnostic, your history taking skills, in addition to laboratory findings. I think I say this all the time, you know. They compliment what you are thinking and what you’re, you know, wondering what’s happening with this client because it can definitely be quite different to what you think. So, if I can just run through the stages, Andrew, just to remind people of what we are looking at as people go through this.

So, obviously, you have your initial exposure to a stress, typically results in your elevated cortisol while DHEA levels will remain constant or even decrease, right? Because we are in this initial…you know, the fight or flight. It’s like, “Oh, my goodness, the sky is falling.” So, the cause of the stress and the vitality and age of the patient will determine if DHEA levels will be lower than expected or normal. So, a young 25-year-old person who’s complaining of, you know, stresses, they should still have a healthy DHEA, whereas someone more like your age, Andrew, would possibly have it a bit lower.

Andrew: I’m young.

Beth: You’re cheeky already. It’s too early in the morning to be so cheeky. The assumption is that the adrenal glands are being assaulted by a stressor, which causes a prolonged effect on the adrenal glands to produce excess and prolonged cortisol. Now, the adrenal glands cannot meet this demand indefinitely. There’s not been ever ending box of chocolates, and eventually, other pathways are compromised to facilitate this cortisol need. Yeah. And so this is where the theory of pregnenolone steal comes into play. So, are you familiar with that, Andrew? You’ve heard of this. Yeah.

Andrew: So, I’ve heard it mentioned, but let’s go through it because it’s really important.

Beth: Yes, absolutely. So, the theory is that all steroid hormones are derived from pregnenolone, right? Which we do know if you look on your chart of hormones. And pregnenolone is made originally from cholesterol. So, you need to remember all our hormones are made from cholesterol. So, we do need some cholesterol in our body. We don’t need to statin it to death, right? Because, yeah, you won’t get sick with your cholesterol, but you’ll have no hormones to live a life. So, I’m off my soapbox about that now. Now, the elevated secretion of cortisol caused by…

Andrew: I’ll get on my soapbox with a tick.

Beth: …all right, yes, just take a number, caused by acute or chronic stress will inevitably result in less pregnenolone available to be a precursor for DHEA production and our other hormones. And that is the need for cortisol to steal that pregnenolone away from the other hormone pathways so it can keep chuffing along, right?

Now, while an increase in cortisol is common in early to midterm stress progression, the notion that there’s this limited pool or, you know, a bucket for all hormones to work with is just incorrect because the transformation of cholesterol to pregnenolone, of course, in the mitochondria, okay? In the mitochondria of each adrenal little cortex cell. And there is no known adrenal pool of pregnenolone just wafting around waiting to be stolen from one cell or another. Okay. There is no known mechanism facilitating a transfer of pregnenolone between the mitochondria of different cells exactly, you know, the zona reticularis versus the zona fasciculata. There’s not a bus that carries them from one to the other.

So, the current scientific understanding is that prolonged stresses do affect the HPA access, and cortisol is often initially driven higher. And this is caused by your adrenocortical trophic hormone, or your ACTH production up in here and your HPA access activation. So, after we see an adaptation by the HPA access, which can be caused by an adaptation to a specific stressor, that could be the cost of lettuce, for example, or the incomprehensible reason why people hoard toilet paper, a down-regulation of the HPA to prevent damage from excess cortisol or both, okay?

So, now in stage two or as this chronic stress progresses, you know, with no end in sight, it becomes a more permanent down-regulation of the cortisol production. So, it’s not that it parks out and there’s none left. Everything is just, okay, let’s pull the reins because we can’t keep on at a gallop. So, not even a canter, let’s just trot, okay? And so now you may see these total cortisol levels but still within reference range. So, this is where you’ve got to be cognizant that you’ll have someone complaining and has a long list of, you know, life stressors. And then when you do their test, you go, “Oh, you’re in normal reference range. You’re fine.” Don’t be that practitioner. What you don’t know is are they on their way up or are they on their way down? Yeah. Were they previously? You know, and you don’t know this if you don’t have a previous test result. Yeah.

So, you just need to be cognizant of that within. And this is why history is important because if they have told you over the last five years they have had…you know, a business has been damaged by, you know, various pandemics, there’s been a divorce, there’s been blah, blah, blah, blah, blah, they’re in this constant thing still, yeah, and it hasn’t gone away. But it may look normal on their test in the reference ranges, okay?

But this may be when we see DHEA lower than expected, yeah, or changes in the diurnal rhythm. So, we should know that cortisol is elevated highly in the morning, or not highly, but it should be the highest in the morning, and then over the day, it reduces till at nighttime it’s ready for sleepy time. And then melatonin comes into place. Yeah. So, we have the diurnal cortisol, melatonin cortisol, melatonin.

Andrew: So, can I jump in there? There’s a few things.

Beth: You may.

Andrew: Firstly, to make comment, and I need to grand standards well. And that is this black box syndrome of when a disease exists and when it doesn’t. Like, for instance, I’ve spoken to patients who had a declining testosterone level because they were on a high level of statins, but a GP won’t treat them, and indeed they’ll send them off to an endocrinologist. And a GP won’t treat them until their testosterone gets to I think it’s five or six.

Beth: And depending on age.

Andrew: But you can definitely see their…yeah. But you can also see their testosterone decreasing over months, not years. We’re not talking, like, an aging decline. We’re talking about quite a quick decline. There was the point earlier when you were talking about exhaustion, “adrenal exhaustion.” And, you know, an endocrinologist won’t believe in that term because adrenal exhaustion equals Addison’s disease. And if you are one mark above that, you do not have Addison’s, therefore, you are “well.” So, this is the issue about this black box thing, rather than as you quite correctly talk about the symptom picture over time showing trends. But I have a question, and the question is repeatability of tests. So, if you, like, for instance, take somebody’s pulse and then you take it tomorrow, well, their pulse can vary depending on an acute stressor, they’ve just picked up the washing, they’ve just lifted something and just sat down and they’re quite excited or something. So, you need to have that repeatability, you know. A pulse should be taken first thing in the morning before food, da, da, da. There’s all of these things say in the blood pressure. What about cortisol? Is it repeated?

Beth: Yes. Absolutely. Well, no, it’s gonna be a bit like a pulse because, you know, today you might have good news, and tomorrow you might have bad news. Or you try and buy things at the supermarket that you can’t get.

Andrew: Five hours [crosstalk 00:16:08] practicing. Yeah.

Beth: Yeah. Exercise, yeah. Exercise will change your cortisol, right? So, I generally will ask someone not to do it if they’re an exercise, you know, junkie. It’s like, “Please do it on a non-exercise day, but do it on an otherwise normal day.” So, I usually want to get them not on the weekend when they’re having a lie-down and having a restful weekend. I want them to do it when they are doing it on a normal workday because work has a lot to do with how people… So, even if they’re working from home, they can do it that they have to, yeah, as I said, do it on a normal workday. No exercise, not if they’ve had a bad night the night before, you know, anything like that. Yeah. What else would I have them not do? Obviously, if they’re not well, yeah.

Andrew: Yeah, yeah. Oh, there’s a perfect one.

Beth: Yeah. So, if they’ve got, you know, a cold, you know, or they’ve run a bad sleep or something, I don’t wanna do it because that’s not generally their norm. I also don’t retest too soon because, you know, if you’re 50 years old and you’re coming to see me, I’m not gonna fix this in three months and let’s do the test again. I generally run on how they’re feeling and how they’re…you know. I find that generally, when you treat them with their story and their results, then the patient is more aware because I explain the results to them, and they have an understanding how they are responding and they’ll go, “Oh, yeah,” you know. The little lights come on, then they change some things about them and they feel better.

So, sometimes I don’t necessarily think I need to retest to prove that we’ve done better because some of these stresses may still be in their world. They’re just responding to them better if that makes a sense..

Andrew: Yeah, absolutely.

Beth: So, maybe if I just explain, if I go through the next, you know, keep going through the stages so we can see how that could be. Yeah. So, obviously, we have that initial stage where everything is on, you know, and then we come into the more adaptive stage as a more chronic down-regulation. Now the assumption here is though that the ACT levels remain high or even increase. However, the adrenal’s ability to respond to that is lessened. Yeah. Again, the pregnenolone steal is thought to contribute to maintaining these normal cortisol levels at the expense of DHEA, meaning that this is where you’ll start seeing the DHEA levels start to go lower or borderline low, and this is what was originally termed as adrenal fatigue. But, of course, that is struck from the record now. We don’t use that word. Yeah. And I usually just tell patients, “You’re just tired because there’s been a lot going on.” I no longer use the adrenal fatigue. I just don’t use it anymore, you know, because they’ll…

Andrew: Yeah. I’m wondering about that vernacular because, like, it’s one of those things. It’s kind of like leaky gut syndrome. We know from Brad Leech that it’s incorrect. There is leaky gut, definitely leaky gut. There’s definitely intestinal hyperpermeability, and then there’s normal intestinal permeability, but there’s no syndrome to it. It’s just leaky gut.

Beth: No.

Andrew: So, this, I’m wondering if this vernacular needs to be worked on to be more physiologically correct. Like, if somebody says adrenal burnout, I’ve never heard of an endocrinologist having an issue with that term because the burnout part seems to imply some psychological issue, you know. It’s really funny, some sort of mental health issue. Interesting.

Beth: Indeed. There is that part of it because, you know, when you got things from…you know. This is the thing. We can’t fix what’s happening in people’s outside world, yeah, because there’s stuff that we can’t fix and perhaps they can’t too, you know. They’re still living in it. So, I always say if I can support you on how you react to the world around you, yeah, that’s the best how we can do it. And so, as I mentioned before, as there’s no evidence to suggest that the zona fasciculata, which is where the cortisol is produced in the adrenal glands becomes insensitive to ACTH or fails to respond over time. The lower cortisol levels are most likely due to the ACTH causing the down-regulation of the HPA exit.

So, it’s still, you know, telling the adrenals please do something, but in a quiet fashion because… It’s a bit like, you know, you’re running a marathon versus doing the sprint, you know, so we have to meet out this cortisol and these hormones adequately so we are not just burning a hole through something that ran out of battery. So, it’s just quieting the body because the body always wants to be in a safe place, yeah, in homeostasis. So, it’s the same as thyroid. It doesn’t wanna be repping into, you know, hyperthyroid all the time and self-destructing, and that’s why, you know, we transfer our T3 into reverse T3. That’s another way of the body reining in over, you know, a carry-on sort of thing. So, I think the down-regulation is a normal reaction to repeated bouts of elevated cortisol. Otherwise, we’d all be, you know, running around doing silly things.

Andrew: Running around with Cushing’s. So, that’s actually a very important point, Beth, because I remember Mark Donohoe and I discussing this in another podcast about the receptors, the adrenal receptors can be down-regulated. But again, does that mean adrenal fatigue, or is that really an adrenal response? So, maybe adrenal response should be a more correct terminology.

Beth: Well, I think it’s the…

Andrew: This is not.

Beth: …maladaptation. Yeah. I know. I mean, it is. It’s a bit like a… What do we call it? We got to call it something so people know. And I think the other thing is if you go Googling, you are still going to see adrenal fatigue this, adrenal fatigue that, right? It’s everywhere. So, people are picking that up. And so if I just don’t mention those words, people are generally happy. They don’t need to, you know. If they understand why and how we are treating them and seeing themselves in colour on paper, they’re happy with that. They don’t need to necessarily have a word for what they’re thinking, especially if I say, “I see this a lot, you know. This is very common,” and blah, blah. People feel better. I actually had a woman come in last week who’d never… She was, you know, in her 50s, never been to a naturopath before, so no pressure from me. But it was great because she was happy because things had been explained to her and she had some understanding then, then she was open to whatever I had to help her. Do you know what I mean? And I think they just need understanding, not necessarily a catch-all phrase of terminology.

Andrew: A label.

Beth: The other thing we need to remember is low cortisol levels can be due to increased cortisol binding globulin, too, okay?

Andrew: Right. Okay. So, let’s go through that.

Beth: Yeah. So, especially the thyroid has…you know, and sex hormone binding globulin. Again, the body will bind some of these things so we don’t have all our chips out at the one time. Do you know what I mean? It keeps some in reserve so it can meet that out, too. So, sometimes if you see…especially in blood if you’re comparing blood to saliva cortisol readings, you know. Cortisol may be higher on the blood and free cortisol may be lower, and this could be because of the cortisol binding serum because you got to remember in the blood they will bind up hormones. So, for example, when you are testing, you mentioned testosterone before, you don’t just measure testosterone, you know. You need to measure testosterone and sex hormone binding globulin. So, then they can… It’s a calculation, but then the lab can calculate how much is free testosterone, which is actually what is the stuff that’s bioavailable. So, we don’t have, you know, a calculation that they do cortisol and cortisol binding then equals this much cortisol. But I just like to get… If I can get blood cortisol, I like to see that, but I still ultimately prescribe and treat off my salivary cortisol. So, again, we must remember that…

Andrew: I was gonna ask…sorry, Beth. I was gonna ask…and forgive me, I was gonna ask this earlier when you were talking about DHEA and pregnenolone steal, and that is, is there any use…? I think you’ve already answered the question, but is there any use in just measuring DHEAS or just measuring testosterone or just measuring these single hormones? We really need to get a sense of the interplay of the hormones and what’s happening in the biotransformation between the hormones, don’t we?

Andrew: Well, that’s right. And if we could get all of those in one go, that’d be lovely, but all of these things cost money, and, you know, we are conscious of when I’m doing tests. It’s not everything that I’d like. I have to work in with the client and their budget and what is gonna give me the most salient information to begin with. And so as a general rule, I will start with cortisol first if the budget is limited. I will start with cortisol first because, in my mind or my experience, that takes longer to go through because some of these people have been in this position with stress for a long time, and so, you know, they’ve really got a groove. They’ve really ground a groove in the way they work. So, we need to kind of fill that a bit, fill that wrinkle so they’re better, and then by default, you know, some of their other hormones made better.

So, everyone knows that if a menstruating woman is highly stressed or what have you, her periods can go taters for a while. So, now is that the hormone’s fault or the stress fault? Do you know what I mean? So, sometimes if I deal with the stress response, so the sympathetic nervous system related to that, you know, they may have a betterment for their less pain or the periods might, you know, just get back on their track a bit more. And then my next step would be then to look at hormones, you know. We get the adrenal support going, so we are supporting the nervous system, their sympathetic nervous system. Usually, that’s what you need to treat, and then we can bring in the others.

And same with the bloke too. With a bloke, I definitely want blood testosterone so I can do the SHBG and the free testo and then see what’s going on there, especially if it’s an older gentleman who is really complaining about fatigue and they’re not what they once were. And, you know, they work and they bum off at the gym but not getting the results, you know. Sometimes that’s low testo. And as you know, men’s testosterone does diminish over time with age, and so then they’re not feeling vital because they’re not having adequate testo, you know, and they prefer to go shoe shopping with their wives. So that’s a big…

Andrew: I love our Aussie vernacular, Beth, and for our overseas listeners, I’ve got to explain that Australians will shorten a long word. So, testo means testosterone, just so you know. We’ll put notes in the show notes.

Beth: Yes. No, you don’t need a glossary.

Andrew: I just think it’s weird. Yeah, but we all do it.

Beth: By now I made a glossary.

Andrew: Australians do it. Yeah.

Beth: We just put an O on the end of everything, and that doesn’t help because I also got Italian heritage, so I have to put an O on everything, too.

Andrew: Right.

Beth: And I’ll start using my hands a bit more often. Yes, so as I said before about the cortisol binding globulin, it is a protective mechanism, yeah, to reduce the cortisol’s damaging effects. That’s what I mean when we put the rein on so we don’t have this blaring inflammation in our body. Yeah. So, the lower DHEA levels will be a product of prolonged chronic stress activation. Yeah. And as I mentioned, aging. You’re always gonna see DHEA as a lower because again in peak of our youth, our DHEA should be pumping, and then it declines over, you know, as we age. Of course, we can make that happen more sooner, but that’s generally you expect. If you’re comparing a 25-year-old to a 55-year-old, you would expect a DHEA base level as to be a bit lower. Yeah.

Andrew: Yeah, yeah. Sure.

Beth: And then generally, if you get to this…

Andrew: But we want a grateful decline rather than a precipitous fall.

Beth: Oh, God, yes, absolutely. Go in style, you know. Yeah, absolutely. So, finally, you know, stage three is where you’ll see the low cortisol and low DHEA. So, this would be more the exhaustion. Do you know what I mean? Again, there’s an assumption here that the ACTH levels are constant and it is a failure of the adrenal glands to be keeping up, right? That’s not necessarily the case. So, why cortisol levels may reach a point of being considered low with associated low DHEA? This again is not necessarily due to the adrenal gland’s resistance, but rather just this chronic HPA down-regulation and ensuing metabolic dysfunction, yeah, because then other things play into the part. You are not just your adrenals. Yeah.

So, this depletion of metabolic reserves, I mean, we are treating patients at this point, can be challenging, and this is where it takes a lot of time. So, this is where I like to start on that first to start really kind of, I say, building up, but it’s just supporting the years of sympathetic nervous system dominance. Do you know what I mean? That these people have had. Because then they will have…and you can see it because that’s when they can have the blood pressure and, you know, the cholesterol and then, you know, blood sugar issues. Everything starts packing in when it’s been constantly revving. We’ve been revving, revving, revving. Yeah.

Andrew: Can I ask a question here?

Beth: I can see you’re about to step in.

Andrew: I am. Can I ask a question here? And that is we always…not always, we commonly frequently think about stress being an emotional upset, but you can have physical stressors. You can have heavy metals that upset your sex hormone binding globulin and your cortisol response. So, how do you look at something like, let’s say, a cortisol awakening response or a daily cortisol test? When do you have to have alarm bells ringing to say, “Hang on, there could be a poisoning here? There could be a heavy metal toxicity or persistent organic chlorine pollutant toxicity going on.”

Beth: Yeah. Well, that’s true, unless they’ve got a very obvious history that, you know, they used to go swimming in, you know, Lake Goop, somewhere, or what have you. I had a client that lived down the road from an aluminum smelter, so hello, alarm bells. But otherwise, it is tricky. And so that’s why I still go back to basics. I’m not looking…I remember when I was trained in diagnostics it was if you hear hooves galloping, just look for the horses first before you look for a zebra. Yeah. So, it’s looking for the jet window. If they’re telling you a story that, you know, oh, my mother is in care and I’m looking after my sick child and my this…you know, they got all these things, I’m not gonna go straight to, “I better check their heavy metals,” right? I’m going to check their cortisol, you know, help them with Nervines and adaptogens and all that and support them that first because I find if you look at some of the core base things, this is where the gut comes into, you look at some core things then see what symptoms are still there then you can go poking around.

I think when we have all these new tests up our sleeve and, oh, there’s this test, that test, we get all excited, “Oh, I’m gonna give it to A, B, and C.” I think it can distract us from keeping to our core, you know, initial naturopathic thing.

Andrew: Surveillance. Yeah.

Beth: We love guts. We love nervous systems. It’s just, you know, support, support, support. So, that’s where I would just be mindful of. And the other thing, you know, again, if we are looking at the adrenals, rather than going into poisoning to start with, you just got to look at some of the basics. And we mentioned Addison’s, right? And so, this is where the stage of adrenal exhaustion that doesn’t exist can be differentiated from true adrenal insufficiency true conditions because you do an ACTH blood test, and if that’s a problem, then you have to get a short Senexon test, and that will determine whether they have true adrenal insufficiency or Addison’s.

And I have discovered three patients with Addison’s by following up on low cortisol levels. They were just flat lining on a saliva. And so then we did blood cortisol and that was excessively low. I was like…Then we sent them on…because you don’t just go one test. You go, “That might have just been an anomaly,” because not every blood test is infallible. Sent them for another one and a short Senexon and, you know, three clients we found with Addison’s. Obviously, these need to be pursued on with, you know, a medical doctor.

Andrew: And you can often pick these patients because they’re eating like a horse and they just cannot put on weight. They just can’t carry weight.

Beth: Well, sometimes because I actually had two sparrows. They were two little sparrow, you know, wavy sort of people.

Andrew: Yeah. They can’t put on weight in Addison’s. Yeah.

Beth: They can’t put on weight. And they had a lot of comorbidities. So, this is where you can’t see the forest for the trees. Yeah. They had this, they had that, all these, yeah, and this is when they get sent to that specialist, you know. They get sent to all the different specialists. And I was like, “Oh, for God’s sake, all of those conditions,” well, because they had Addison’s, you know. And these people need long-term or lifelong hydrocortisone therapy, so they must be forwarded on. So, you know, if any practitioners are really concerned, please refer on. Do you know what I mean? Because hypocortisolism is a real thing. And so you also to be need mindful of histories, again, because low cortisol can also be seen, not just in Addison’s, but in PTSD, in chronic fatigue syndrome, in fibromyalgia, you know, some depressive and affective conditions, okay? Which is rarely due to the adrenal function directly, but again is more likely to a response to the previous hyper cortisol because of trauma. It’s trauma being so chronically fatigued. Do you know what I mean?

Andrew: Yeah.

Beth: All those sorts of things. So, you need to… Again, we need the story about why would we expect to see that so low? And so because consequences of this is the inflammation and the immune system and general, you know, pain, it can be increased in pain. Yeah. So, you know, I think this is where it’s more about the HPA access, you know. Dysfunctioned, I don’t like either, because it’s still a normal function of it trying to rein it in, you know, when we are down-regulated.

Andrew: Oh, that’s very good. That’s very wise. It’s actually our body protecting us into homeostasis.

Beth: Exactly, exactly. So, yeah, it’s about homeostasis. So, this way even, is it a maladaptation? I don’t even know about that because it is about trying to not have it spontaneously combust. So, yes, we need to have a think tank.

Andrew: So, maybe this is where instead of these terms that we commonly use, we should indeed be looking at what you said earlier, terms that sit more naturopathically like vitality, like nourishing, rather than blocking and upping and downing inside. We should be using these more seemingly wishy-washy terms, but indeed they’re correct.

Beth: Yes. And I do find then that clients…you know. The amount of times that I go through a…so I use cortisol awakening response test. Yeah. And I can go through that and explain how that kind of works. I like that because then you get the picture on the paper to talk through with the client, and you can kind of say, “See, this is you in the midmorning or the afternoon, and you’re at, you know, a low number.” So, this is where, you know, the chocolate biscuits and the coffee come in. This is when you’re looking for a coffee and a biscuit. Yes. How do you know? Because you’re looking to pep yourself up again to get through the day. This is all about getting through a normal day, you know. Yeah. And it’s a bit of a slog for people, especially if you’re being down-regulated and you are being reined and you’ve gone, “But I got a deadline to, you know, get to,” you know.

Andrew: Yeah. Just a question, I guess, about the cortisol awakening response tests, which is three quick succession tests in the morning versus the daily cortisol tests which looks at diurnal variation throughout the day. Can you just…? Forgive me. To preface this, I find that there’s quite a big discrepancy in the amount of the tests. Can you not just do a normal daily cortisol but do them in quick succession as though you were doing a cortisol awakening response, a car? Because you said yourself, what is it? Forty bucks? Sixty bucks?

Beth: Yeah. But then you’re not getting the proper reference ranges. Yeah. And I find that the lab won’t give you a proper reference range because you’re just gonna do… They’re just random. Yeah. They’re not set up to do that car response if you just go, “I did this every half an hour.” It buggers up the lab in that sense. They’re just not set up for that. But also I want the…because I used to use the four diurnals because that’s what we had. But the car now is far more potent because you can have someone who during the day looks relatively okay with their numbers as we discussed before, but their awakening response is backwards, or you can actually see that they wake up elevated, they go off the scale and then they collapse, you know. So, then you know, well, this is now more about up here already putting the reins on. Yeah. And this is a lot of this pre-anticipatory stress. Yeah.

Andrew: Yeah. Beth, there’s so much to go into. I mean, this is a symposium in itself, but we need to get onto things about how you support your patients. And obviously, there’s a lot of psychology and a lot of counseling and things like that, but can we talk about supplements and lifestyle and dietary interventions that you use that you find work? For instance, you know, gin sinks, you know. We’ve got nervines. How many nervines are at our fingertips? We’ve also got nutrients, vitamin C, B5, the B complex indeed. So, what do you use? What little hints and tips can you give us about what you find works, and what might be cautionary things?

Beth: So, generally, I’ll have a look at what they’re doing in their life, you know. And one thing that I find with a lot of people that are very exhausted and just…and they’re exhausted because they’re running around in their head, you know. What we have to remember is people think stress is running around, a lot of screaming, okay? It’s not just physical stress. It’s not just… Remember over-exercising is a stress, right? So, there’s that, but it’s also the running around we do in our head thinking, thinking, thinking, you know. And practitioners know this because every client you see, you’re thinking, thinking, thinking, thinking, “Well, how am I gonna do this? What am I gonna…?” It’s constant. And even though I sit like this all day talking to people, it is exhausting because you constantly…you know. It’s an effort. You’re using energy in your head.

So, I find that a lot of people, especially a lot of people now working from home, so if they’re on the computer working from home, then it’s like, well…and your home is your sanctuary perchance. Perchance there’s another stress if it’s not. But, you know, I often say what do you do for joy? And it’s surprising the number of people that have nothing. There’s crickets when I ask that question, you know. So, it’s trying to find that to fill us up, you know.

Another thing is adequate and restful sleep, a restorative sleep in a dark room to help melatonin do its job, right? To counteract the cortisol. So, you’re getting restful and you’re recharging. That helps recharge your batteries. That helps recharge your adrenals, you know. Is very important.

And the number of people that, you know, come to me with five hours’ sleep. What? That’s unacceptable. We need, you know, better sleep. Sun exposure. Again, if we’re all working from home now, it’s fine if you live in a sunny place and you can sit out on the veranda and tap away, but how many people are still just in an office room without the sun? And sun is important again for our circadian, you know, because of the circadian connection and the diurnal rhythms. Get out in the sun. Start your day in the sun, you know. Exercise is good just because you are expending some physical energy. So, I’d generally… Look, I’m happy if people just walk. Just go for a walk. Doesn’t need to be the gym and pilates and all of this, just movement, yeah, and correct breathing.

I often teach people just so…you know, not this shallow breathing where they breathe and their shoulders come up, you know. It’s actually belly breathing because that helps your heart rate variability, too. Always look at their diet, of course, and especially if their cortisol is excessively high. I’ll look at carbs because people will be having carbs to keep that kind of motor running, you know. Like I had a client once. She was, you know, just high as a kite on the cortisol. She was highly anxious and she told me how well she eats because she eats 10 serves of fruit a day. The trouble is that’s all she ate in the day was 10 serves of fruit, which is basically I call it sexy sugar. You know, it’s feeding into that stress, yeah, because it’s gonna elevate the blood sugar, what have you.

And then beautiful nervines. I love, you know, things like your magnolia, your passion flower, kavas. I love kava, especially in the evening when people…if they’re still a bit high in the evening. So, if on a test they’re high in the morning, you can’t get in the morning to close those down. I usually make sure their nighttime is sedated, you know, so they’re calmed in the nighttime. So, there’s less of an aggravated rise for the morning. So, again, if they’re getting a better rechargeable sleep, they’re less inclined to be meerkats first thing in the morning. Then, of course, there’s the lavender. That’s my other one is lavender. And there is a product out there that you can get magnesium and lavender, which I love it because it’s very relaxing at nighttime for my clients and for myself.

And then, of course, HPA access is the main target for any of our primary adaptogens, our herbal adaptogens. So, they come in… Yes, there’s the ginsengs that…Now, I don’t like panics especially if you’re wired and tired. They’re already, you know, sprung tied. Don’t stimulate them anymore. And this is important if…you know. Back in the day when you would just go…someone come in and go, “I’m tired,” and you go, “Here’s some panics that’ll do the trick.” It can make them feel way worse.

So, I do like more looking at my Siberian ginsengs, my American ginseng, my rhodiola. Rhodiola is lovely. And then, of course, oh, Romania. Romania is good too for chronic stress, but then Withania or your ashwagandha is fabulous because that can definitely strengthen your adrenal glands in response to external stresses and allow for a more positive stress response. This is really what we are looking for is a more positive response rather than a hysterical response. And that’s where Withania during heightened stress helps reduce that excessive. Yeah. And you can get now products that have numerous proprietary extracts of Withania, which is great. There’s one, which one is sensoral, which uses root and leaf, which is a little bit different to what we traditionally use. But in clinical studies that has been shown to have higher quantities of the standardized bioactives that we are looking for, which is excellent because they need less to get a good effect.

And another sensory product is chardon, which has been shown to have 21 bioactive… How do they say? With that alliance? And it is one of the highest potency available, you know, so it’s incredibly Zenifying, and so that is a ripper for your wide and tides because it just is… I call it my herbal fluffy jumper, you know, because it’s just…or a cardigan really. It’s a nice…it’s not too…

Andrew: It’s a cardi.

Beth: It doesn’t… It’s a cardi, another Aussie vernacular is short for cardigan but makes a fluffy cardigan. So, it’s just, you know, warm and cozy and it just very Zenifying and, you know, just chillaxing, really. And the other thing I like is…

Andrew: I love the psyche of Withania.

Beth: Withania? Oh, you can pretty much use that quite comfortably. Probably, you know, as we’re always a bit nervy with pregnancy, it doesn’t seem like you can do anything with pregnancy, even though I have used it. I just, you know, monitor my dosing, but I find that really nice. The other thing I like is L-theanine, the amino acid because that has been shown to reduce glutamate release and increase your inhibitory neurotransmitters such as GABA, which we know has an anti-anxiolytic effect, which, again, is very important for that heightened cortisol in those first stages of the stress response, and it has been shown to approve alterations of HPA access by modulating the diurnal rhythms of cortisone and ACTH. So, that’s ace. Yeah. So, again, that’s another one that is really easy to, you know, add to a magnesium powder or add to a smoothie, you know, to just keep a steady zen thing going on. Actually, one study stated…

Andrew: You take quite high doses of that too, like 400 milligrams a day?

Beth: Yeah, though the studies that I was reading had just done 200 migs, which is not a lot. And one study actually said that it had the potential to promote mental health in the general population and stress-related ailments and cognitive, you know, impairments, which is that’s the other thing that forget people. People kind of go, “Oh, and I’m losing my memory, and I can’t remember this, and I can’t this.” It’s because you’re stressed out of your brain. This is when people think, “Oh, I think my mother had…” I don’t think you’ve got Alzheimer’s just yet. I think you just…you know. The monkeys are running around in your brain, and so you just can’t remember everything, you know. You have to write a list. It’s hard to get through your day. But my ultimate favourite is phosphatidylserine, which is a phospholipid.

Andrew: So glad you mentioned this. Yes.

Beth: Oh, I love it. I love it. And it’s been a bit hard to get with various supply issues across the world, but it is a fife because it’s kind of a quickie that you can take. It’s a bit like a Panadol for your adrenals. It’s like if you feel… So, how I explain it to people is if you know when you feel like you’re an 11 out of 10 on the anxiety scale, you pop your phosphatidyl, and within 15, 20 minutes, you’re more down like a 7 out of 10, so then you can actually think a little bit clearer and, you know, react or respond differently. So, I find it great. You can’t really OD on this it just doesn’t do anything if you just keep popping them but…

Andrew: No, you need to load. What I’ve always said to people is the first month is gonna be horrendously expensive because you’ll be using, like, three or four bottles of, you know, let’s say 100 milligrams 4 times a day. So, you need to load the dose, but from then on it’s like 100 milligrams a day. It’s fine.

Beth: Yeah. I mean, I find now that, for myself even, I just use it like a Panadol when I just feel, oh, here I’m revving up too high. If something happens, you know, like if you have a bad instance in the traffic and you get proud, you know. It’s kind of like a rescue remedy sort of thing. It just brings it down because it’s actually known to counteract the exaggerated release of ACTH and cortisol. Yeah. So, they even use it with athletes.

Andrew: Athletes, yeah.

Beth: Athletes use it to reduce excess cortisol after the exercise. So, that’s why we probably can’t. We’ll be having trouble getting it. It’s all at the Commonwealth games at the moment for all the athletes over there. So, yeah, it’s wonderful because people can carry it around in their bag, you know, whereas some of our herbs, you know, Withanias and our L-theanines and what have you are more like an ongoing thing. I feel like you say once you’ve loaded with phosphatidyl and brought someone to a more manageable level, then they can just have it like a little safety capsule there they can have when they’re feeling a bit wound up, opposed to when they’re feeling flat. This is more when they’re feeling, you know, that anxiety is coming to get them.

And then, of course, you know, you mentioned vitamin C and the B complex before. People get B complexes because, you know, you need your Bs and magnesium. Magnesium and Bs would be your definite, and then you add, you know, what have yous. But again, I wanna remind people about the different magnesiums on the market, and just because your client says, “Oh, yeah, I’m on magnesium,” you don’t go, “Terrific where you go.” No, you’ve got to look at ones that are bioavailable. So, there’s things like magnesium, which is a combination of magnesium and phosphorate, and it has very high magnesium content, over 12% higher than other organic salts such as your lactates and your citrates. And clinical studies have shown that this is actually more readily assimilated and digested than other magnesium salts, even over and citrates. So, that’s something to be mindful.

Andrew: Got you. Yeah.

Beth: And the other thing that I like, if someone’s got a bath, is a magnesium salt bath because they’re fabulous or relaxing, and especially if you also add…you can add a little bit of lavender, you know, essential oil into that bath. You might also have to then have a strainer handy to scoop those people out of the bath because they will be so relaxed. Because definitely if I do that, I need to be laid out and popped into bed because it’s a good night for me, you know. . Yeah.

Andrew: Beth, there’s so much that we could cover. Again, like, it really is a seminar in itself about what we can do, Beth, thank you so much for taking us through these very salient points, not just from the language, but also how we support our patients and how we tease apart what might be wrong. I love the way that you always go back to simple things. I will counter you in one thing you said, and that was that you said, “If you hear hooves, think horses not zebras,” of course, that’s unless you’re in Africa, in which case you need to think of Zebras. I was talking about toxicity. Somebody is working in a toxic environment.

Beth: But you probably need to think of lines.

Andrew: Yeah, yeah.

Beth: Yes, and lines as well.

Andrew: But I also love the way that you talk about not happiness, not exercise, but you talk about joy, and you also don’t talk about how many hours of sleep. You talk about did you get restful sleep. Was it rejuvenating for you? So, it’s these actually clinically meaningful terms rather than, as we spoke about earlier, that black box of a label that people use. I love the way that you actually care for your patients. It’s wonderful to see. It’s wonderful to podcast with you once again. Thanks for joining us on “Wellness by Designs” Beth Bundy today.

Beth: My absolute pleasure.

Andrew: And thank you, everyone, for joining us. Of course, all of the show notes and the other podcasts are gonna be up on your favourite podcast app and the Designs for Health website. I’m Andrew Whitfield-Cook. This is “Wellness by Designs.”