Adrenal Fatigue, Adrenal Failure and the Cortisol Rollercoaster – Podcast #60
Dr. Justin and Evan clarify the issue of high cortisol levels versus low cortisol levels as well as how you can get tested for them. Find out which labs are recommended, what to look out for on your adrenal cortisol tests, and how to get a customized specific protocol in today’s interview.
Get in-depth information about the importance of healthy cortisol levels in our body and the various roles it play for body function. As far as methods of treatment are concerned, discover why functional model is superior than the conventional model. Also learn helpful exercises you can do to aid in your healing process. Get tips on how to start your morning to reduce stress and negativity in your life.
In this episode, topics include:
1:50 What is cortisol
11:03 Symptoms of adrenal issues
14:03 Methods of healing, functional vs conventional model
18:42 Treatment or the healing process
Dr. Justin Marchegiani: Evan, it’s Dr. J. Evan, what’s going on, man?
Evan Brand: Hey, not too much. I had my own protein today. I was just telling you about it and it–it’s still delicious. I–I feel like when I was pitching my protein this week on my own show–
Dr. Justin Marchegiani: Yeah.
Evan Brand: I felt kinda like, man, I have to say it’s delicious. But it really is. I’ve had a lot of people send me stuff and you probably get stuff sent to you, too, to test things out and organic vanilla bean is a real deal. It’s not that fake–fake vanilla bean, that natural flavor vanilla–vanilla bean that comes from beavers anal glands.
Dr. Justin Marchegiani: Oh, my gosh! I can’t believe that. So your whey protein, it–it’s grass-fed, right?
Evan Brand: Yeah. And–
Dr. Justin Marchegiani: High-quality stuff like that?
Evan Brand: Yeah and there’s collagen in there, too. I think I was–
Dr. Justin Marchegiani: Ooh.
Evan Brand: Getting fairydusted at first, so I told him I wanted 14 grams of–it’s a 20-gram scoop so I told him, you know, 14 grams I wanted to come from the grass-fed whey and then 6 grams I wanted to come from collagen, and I can feel it. I don’t know if that makes sense. I can feel when it goes into my body.
Dr. Justin Marchegiani: Dude, that’s awesome! Anyone listening to the show, feel free to check out Evan’s site at NotJustPaleo.com. Get some good quality whey protein with some collagen in there. That’s good stuff.
Evan Brand: Yup. I–I’ll send you some, as soon as we–as soon as we run this batch, I’ll send you a–a few bottles of each.
Dr. Justin Marchegiani: Yeah, I’m a huge fan of collagen honestly. I mean, there’s all kinds of good benefits for it just for like healthy gut function and stuff, but let’s just say you’re vain and you want the aesthetic stuff. Great hair, great skin, great nails. I just actually saw Dave Asprey out a few months back and you know, Dave’s got his new hairstyle, right? Dave’s the–the Bulletproof exec and I said, “Dave, what the heck’s going on with your hair? It looks really different.” He was like, “Dude, I’m just upping my collagen levels.” So I’m just like, “Hey, collagen’s good for him. It’s good for hair, good for skin, good for nails, and there’s a lot of health benefits outside of the aesthetics.” So in my opinion, it’s a win-win.
Evan Brand: Yup, definitely.
Dr. Justin Marchegiani: So in our pre-game talk here, we chatted about cortisol. We felt like that this would be a really good topic to kind of bring to our listeners. So why don’t you get the ball rolling, Evan?
Evan Brand: Yeah, so I wanted to talk about this because cortisol is a buzzword first of all, so people aren’t gonna be like, “Oh, great! Cortisol.”
Dr. Justin Marchegiani: Uh-hmm.
Evan Brand: But I think a lot of people have been convinced that high cortisol is always the case and people think, I have high cortisol and it’s causing me all my problems but not one adrenal cortisol rhythm test that I’ve reviewed has had high cortisol. Every single one is low. Everyone’s lower than they should be and that’s causing more problems. I mean, high cortisol is a big deal but I think more people have been burnt out or burning the candles at both ends longer than they–than they realize. And so that high cortisol stage, you–you’ve already passed that, now you’re in the low cortisol stage because you’re running on fumes anymore. You’re not just being chased by the tiger. You’ve been chased by the tiger for 40 years and there’s nothing left to help you run from that thing.
Dr. Justin Marchegiani: Absolutely and cortisol is actually good for you. Like you said, most of the patients that we see, we run this salivary cortisol rhythm test and again, a salivary cortisol rhythm is looking at the free fraction of your cortisol so I know a lot of people may get confused because they may have had their conventional doctor run a cortisol and that’s typically via blood and blood primarily, actually it’s only testing for cortisol, the serum, the protein-bound cortisol. So imagine this, imagine you got–here’s my analogy for the day. Now each day I kinda pull one of these out from you know where and help it resonate to people. So 2% of hormones are–are typically free fraction. So imagine a baseball going into a catcher’s mitt, right? That’s your 2% and the other 98 out of 100 are beach balls, right? A beach ball is too big to fit into that catcher’s mitt but those baseballs can fit into the catcher’s mitt. So a lot of the–the beach balls for instance are the 98% that are protein-bound, right? They are made by the gland. It’s a good measure of glandular function which is great in conventional medicine because when they were testing for disease, right? Pathology of the gland, it’s great to measure the beach balls because the beach balls represent 98%. So it gives us a good window at actual gland output. But because the beach balls are so big, they can’t get into the catcher’s mitt. So we look for the baseballs and the baseballs are the free fraction. They don’t have a–a protein carrier attached to it so they can actually go into that catcher’s mitt or in actual physiology and biochemistry, they can bind into that receptor site and have a metabolic effect.
Evan Brand: I like that. That’s a good analogy. So you know, the thing with cortisol like I’ve mentioned, in the morning, you want it to be high. That’s normal.
Dr. Justin Marchegiani: Yes.
Evan Brand: That’s the time where high cortisol is a good thing and a lot of people wake really early for work. Sometimes 5AM and they go to the coffee to get them up but in reality, if you don’t need as much time in the morning, say you can push your schedule back a little bit and try to wake up closer to 7AM or closer to the actual sun up time, if you’re getting up before the sun and you can change that to–to getting up at sunrise, you’re basically–I’m gonna use my analogy that I mentioned to you–if you’re getting up at 4AM to get ready for work, you’re only going halfway up the hill on your favorite rollercoaster before you start going back down the hill. So you’re gonna get to the bottom of that hill a lot of quicker and it’s not gonna be as fun of a ride for you as if you were to get up closer to sunrise time or 7AM and now you’re at the top of that rollercoaster hill, that’s gonna be a really fun ride and you’re gonna have a lot longer distance to cover before you get to the bottom of that hill and that’s why people that are waking up too early or people that are not pumping out enough cortisol in the morning, by noon, they’re bottomed out and the fun’s over for the day. You might as well close shop and give up.
Dr. Justin Marchegiani: Exactly. Exactly. And again, cortisol typically goes low with chronic stress. So if you see low cortisol, at one point you were probably in this high cortisol space. And we kinda go back in the history, when we–we kinda do an exam and intake, you know, going back in time, was there a place where you were under a lot of stress but you felt good? Like you had energy, you may have been stressed, you may have been anxious but you had the energy, you know, behind you to do all the things that you needed to do, and then at some point, it started to teeter out where, you know, you’re having less energy, you’re feeling more fatigue, you need more naps, you need more time sleeping, you spend more time resting on the weekend, and most people when we do a detail history, we see that pattern kind of unfolding and we progress, that’s called stage 1–again, depending on what lab you use, there’s a lab called Diagnos-Techs out of Washington, they have like a 7 phases of adrenal fatigue–I like keeping things really simple. Again, if you’re not able to break concepts down into simple easy to explain analogies, it just tells me you don’t really understand that that well yourself or you’re just a bad teacher, one of the two. Hans Selye called the alarm phase if you will, and then state–phase 2 or stage 2 is when that cortisol is dropping. Typically what categorizes or what’s characteristic of a stage 2 is we start to see some rhythm perturbations, some rhythm abnormalities, maybe a high morning or a low afternoon or a–a high late afternoon or a low night. We’ll start to see some rhythm imbalances and some drops in DHEA, in your sex hormones. And then stage 3, we’ll start to see it drop beneath 23, I think it’s picomoles per liter is the amount that’s typically used on your conventional salivary labs. Don’t quote me though, but you know, if you’re running like your Biohealth or your Diagnos-Techs, labs like that, that’s your conventional range, and you’ll start to see that go beneath 23 units, you typically see 2 or more rhythm disturbances and you’ll see lower or low DHEA on that as well.
Evan Brand: How often is it for you to see all 4? Almost every single person I run that on it all 4, they’re low all day. They’re below morning, below mid-day, below evening, and below night. I mean, I’ve never had anybody that’s been in range on all 4 actually.
Dr. Justin Marchegiani: I totally agree and frankly with–I’d say with majority of patients, I really don’t need adrenal cortisol tests because I just tell by symptoms and by talking with them, but at the same standpoint though, my patients need to see it. They need to see it’s real and then it’s really important that be able to see it, make a change, go back and re-test, and see it get better. That’s like a really important thing. And again, there’s a couple things every now and then we run these tests, I can’t predict rhythm disturbances. So for instance, I’ll be like your stage 3, but then they’re low in the morning, high at night, they’re DHEA is low, and you get surprises. So one, you gotta run the adrenal test just to see where you’re at because the weaker your adrenals are, the longer it’s gonna take you to heal and also to heal your gut because we need cortisol to heal our–our guts and to put out the fire in our guts. So typically, if you’re doing a good questionnaire and most people are gonna be stage 3, but we need to see it. People need to see it’s real. They need to see what kind of rhythm disturbance is there. They need to see where their DHEA is at and then it’s great to create a program, come back, re-test it, and see rhythm come back into effect. See cortisol levels go up. See DHEA levels improve. It makes a huge difference for people being on track. It also gives them a sense of how long it’s gonna take to get better and then it also really keeps them motivated and allow the functional medicine doctor to create a–a customized specific protocol, not a general one which would–would be what I would be stuck doing if we just did it based on symptoms, it’d be a very general protocol. But with the labs, we can create a specific protocol so instead–instead of pulling out the RPG or the bazooka, I can pull out the sniper rifle and really target the exact rhythm, because it’s not just giving support, we also wanna really target the rhythm so if we’re low in certain areas, we wanna use certain nutrients to bring it up. If we were high on certain area, we wanna use certain compounds to bring it down and we wanna time it throughout the day so we’re mimicking normal hormonal physiology.
Evan Brand: Perfect. That’s great. That has actually improved some of the stuff that I was doing, because before when just like you said I can assume that a lot of people are gonna have adrenal issues but I didn’t know exactly what time so if I was gonna add in say an adaptogen or if I was gonna add in something like some phosphatidylserine, it’s like, “When do they need it?” And I can use generalities but now that I’m actually running more of those, I see like, “Man, it really is a good idea to run this even though I probably already knew what it was gonna tell me. It’s just a little bit more accuracy.” Let’s talk about some of the symptoms of some of these issues people may be hearing this and they’re thinking, “Huh.” So I had just a couple written down here. One being fatigue. Another being aches and pains or you wake up and you don’t feel refreshed, maybe you feel tired even, even after you have–
Dr. Justin Marchegiani: Uh-hmm.
Evan Brand: A full night of sleep.
Dr. Justin Marchegiani: Yeah.
Evan Brand: You wake up and you’re just like, “Gosh!” Lightheadedness is something that I see a lot. Poor balance, just like you stand up and you’re like, “Whoa!” Crashing after meals, cravings, mood imbalances, headaches, digestive stuff. Another one that I don’t have written down but I experienced personally was a loss of muscle at first. I guess in that first phase, that high cortisol, basically catabolized my muscle.
Dr. Justin Marchegiani: You are a weakling.
Evan Brand: I know. I’m building back up now. I’m feeling good now that I’m–got my–my protocol under control. But what other symptoms? I mean, have I covered kind of the main things that–that you see as well?
Dr. Justin Marchegiani: Yeah, I know and actually, you are–you are putting on a lot more muscle, Evan. I–I can totally notice that. We gotta bring the show to video format so you can flex for listeners next time.
Evan Brand: Sure.
Dr. Justin Marchegiani: But yeah, you are 100% right. I’d also say allergies are a big one. Joint pain, right? People that are chronically in pain. Like think about it. When you go to the joint doctor, you know, you’re a–I think it’s a rheumatologist or orthopedist, I mean, they’re gonna give you a cortisone injection and cortisone is the cousin or sister of cortisol, right? We have our natural anti-inflammatory being produced by our adrenals called cortisol, which we already talked about, and if we break the word cortisol down, it’s really a glucocorticosteroid. And again, like we talked about, right? Medicine loves to use big words that keep people in the dark and feel confused. So we just break it down. Gluco pertaining to blood glucose/energy, okay? Corticosteroid pertaining to stress and inflammation, right? Corticosteroid injection, right? Corticosteroid for inhalers. Corticosteroid for creams. Corticosteroid pills for pain, right? So pain, inflammation, stress, energy. So this is kind of the big things that cortisol are incredibly responsible for but we also need healthy levels of cortisol for thyroid hormone activation, right? Goldilocks effect–too high, we shut down and block the thyroid; too low, we can’t convert and activate thyroid hormone. We need cortisol for healing or address inflammation in our gut and–and being resistant to common allergens. We need healthy cortisol levels to maintain energy and blood sugar throughout the day so we’re not having to eat every two hours like, you know, like you’re grazing, like you’re an animal. And then also, just we need it to be able to help detoxify it. Cortisol has a role in detoxification. Alright, so we need healthy levels of cortisol just to be resistant to stress in the environment.
Evan Brand: Yeah, so let’s about–I wanna get into some–some methods of healing, if you will. But maybe you could spend a minute or two explaining kind of why the functional model of looking at this is superior to the conventional model, because you’ll hear–hear people even they don’t even have in their consciousness an issue of adrenal dysregulation, they may just think that they need this cortisone shot.
Dr. Justin Marchegiani: Yeah.
Evan Brand: And that’s not going to actually fix what’s going on.
Dr. Justin Marchegiani: Absolutely. So first off, I’m gonna get to that in a roundabout way. I feel like a politician answering your question here. So when we look at your cortisol rhythm, there’s 3 things we always wanna prioritize. Most people just look at the–the number, how much cortisol you’re outputting throughout the day, right? And that’s kinda what conventional medicine does, right? Addison’s disease, super low cortisol. Cushing’s disease, right? Cush–push, that means high cortisol, alright? So we’re looking at amounts with the conventional medicine. In functional medicine, we’re really looking at rhythm. We’re looking at what’s your cortisol rhythm like? And a lot of these has to do with the HPA axis, the hypothalamic-pituitary. These are glands that sit a couple inches right between your eyeballs, right between your eyes and they–they’re master controllers. They talk down to the thyroid, to the adrenals, to the gonads, etc. And again, they talk to the adrenals and they help regulate cortisol. So when we’re stressed, those glands, that tissue loses communication and we start seeing the aberrations and the perturbations in the cortisol rhythm. And that’s one of the most important things we like to look at first. The second is cortisol amount. The third is then DHEA levels. So when we talk about the word adrenal fatigue, we’re not–we’re not talking about it from the perspective like a pancreas that’s fatigued and can’t make insulin. There may be some fatigue in the gland but a lot of what we’re talking about is HPA–hypothalamus, pituitary, adrenal–just think brain talking to adrenal, that type of communication, that thermostat that talks to your adrenals or the thermostat that talks to your heater or your A/C in your house is broken, so to speak. And just because the A/C or the heater isn’t running properly, it may not be the actual heater or A/C. It may just be the thermostat. So a lot of what we’re doing yet, we’re supporting the actual gland, that–that’s cool. But we’re also supporting the brain. So I think when we’re doing a lot of these programs, we’re still working on the brain just as much as we are working on the adrenals.
Evan Brand: Uh-hmm.
Dr. Justin Marchegiani: Okay? Go ahead.
Evan Brand: No, keep going, that’s great.
Dr. Justin Marchegiani: Now, getting back to the original question you asked me to begin with. When we look at conventional medicine, conventional medicine really what they’re looking at, they’re looking at adrenal failure. There are probably a hundred patients over the years that we–you know, after our consult, we review what’s going on, they go to their MD, they–they show them the tests, they talk about and they say, “You know, your doctor’s crazy. You don’t have adrenal fatigue or adrenal failure.” Because they–they equate adrenal fatigue to Addison’s disease or adrenal failure where cortisol gets super, super, super low where you can’t regulate inflammation and the body starts shutting down, right? So they equate it to that in their mind, because that’s what adrenals to them means, because they’re on a pathology-based state, not in a functional state. So they come back and they’re like, “Well, I don’t have adrenal fatigue” or “I don’t have this adrenal imbalance,” and then we just have to differentiate, right? The conventional doctors looking at disease, that’s Addison’s disease. That’s super, super, super, super low, low cortisol levels typically caused by an autoimmune condition that starts to destroy the adrenals. So we wanna realize that. Let’s say on a spectrum of 1 to 10, 10 being optimal adrenal health and 1 being Addison’s disease, you gotta be at a 1 to have Addison’s, right? That’s kind of our subjective criteria but most people that are going into the doctor maybe are sitting at 3 or 4 or 5. And again, they are far away from 10, right? But they’re not near 1 yet and they may not–they may never even get to 1. So they’re going to their doctor and they’re just saying, “Hey, what’s up?” And then their doctor says their fine but they’re really not in a good place. So we’re looking at things more from a functional perspective not a pathology perspective, and that’s the–the main thing and again, most people are at 3 to 5 on that subjective range, so they’ll never ever be helped. They’re never ever fall into that adrenal failure criteria, but they’ll have dysfunctional adrenal fatigue primarily driven by HPA–brain, poor brain adrenal communication by chronic stress and it’s our job as the functional medicine doctor to figure out where that stress is coming from, nutritionally, diet-wise, obviously all the emotional and lifestyle stressors, and then even bigger, the internal infection, toxicity stressors.
Evan Brand: Yeah, so let’s get into the–if we can use the word treatment or the healing process. Something that I like to start with is the exercise looking at that a little bit closer because–
Dr. Justin Marchegiani: Oh yeah.
Evan Brand: A lot, a lot, a lot, a lot of women think they have to do 6 days a week of their spinning class or 6 days a week of their CrossFit class, and then they combine that with 2-3 mornings of yoga and then they combine that with another 2-3 afternoon workouts of weightlifting and that’s like, “Holy crap!” It’s like no wonder you’re so low. So that’s kinda almost the first starting place for people because at a certain point, too much or too intense exercise is gonna tax the system and if we’re trying to rebuild it with some of these methods that we’ll get into it, you’re just spinning your wheels. So I like to just tell people to go for a walk. If you live on the beach, go for a walk and get the wet sand in between your toes and try to reduce some stress that way. If you like to go swimming, that’s a good way to do it if you’re not in chlorine pools, if you can get access to some saltwater pools or something like that or a walk in the woods, just walking. I think that’s like one of the most restorative but helpful exercises I could prescribe if you will.
Dr. Justin Marchegiani: Absolutely and I have a 3-step criteria that I use to help kind of evaluate whether exercise is positive stress or negative stress and you gotta answer positively to all these questions. So number one, do you feel energized after your exercise? Alright, do you feel good after your exercise? Number two, 10-15 minutes after you complete the exercise and you kinda caught your breath and such, how do you feel? Do you feel like you could emotionally repeat the exercise again or you’re just like, “Holy crap! Like get me the heck out of this CrossFit box,” like “I’m done,” you know? And then number three would be, how do you feel that night or that next morning? You know, barring, you know, you didn’t do any new exercises and you’re not gonna be sore because the movements are different and you had a good night’s sleep. Barring all that stuff, how do you feel? Do you feel hit by a bus? So those are kind of my 3 questions that we need to answer positively for. If we don’t, then one of the first things we have to do is cut down the duration. So if we had an hour-long workout 5 days a week, well, we’ll just cut it down to half hour or 45 minutes then we can also cut down the intensity. I find most people do good with intense movement patterns depending on how fatigued they are but just keeping them really short and that could be a Tabata and if you’re really adrenal fatigued, that intensity could be a–a fast walk to a slow walk kind of interval, to someone swimming, to a– you know, let’s say they’re–have a lot of joint issues, we can even do movements that are in water that don’t have the impact or using an elliptical or rower so we’re not slamming our joints down. That could be another way we could involve that interval-type training. And then if we’re still really in–in a bad place there, then just things like walking in general, even incorporating tai chi or qigong if we’re really extremely fatigued hormonally.
Evan Brand: I like qigong. I tried to get–get Hannah, my wife, to do it and she just laughs every time I start doing it in the living room.
Dr. Justin Marchegiani: Absolutely, you got it. And I just wanted to add one more thing, too. When you’re conventional doctor is testing for your cortisol, we already talked about that they’re looking at your protein levels, just your typical cortisol sum, cortisol serum, so if you see serum that means it’s protein-bound. Again, the only way you’re gonna know it’s not protein-bound is if it says free, free next to it. So typically if you’re running like your thyroid, they’ll run thyroxin T4 free and you’ll see that word free, so that’s important. But number two on that, it’s pretty stressful to get–for most people to get a blood drawn. It’s like you get that needle, you get the white coat syndrome, they–they wrap the rubber band around your arm, you’re–you know, you have those memories maybe when you were younger getting stuck. So that can be stressful in and of itself and stress increases cortisol, right? So you can get a lot of people that they’re blood cortisol actually looks a lot better than what it would be normally because there’s actually a stress response when you’re getting the cortisol drawn. And that’s why we love the cortisol labs because there’s no, you know, stress spitting the tube. If you’re sitting there and you just spit in the tube. That’s it. So it’s–it’s great that we can elicit a measurement without causing a stress response.
Evan Brand: Yeah, instead of adding in other things, I’d like to talk about subtracting things from people’s lives and one that’s really helpful is negativity. Now whether that’s watching too much news or that’s just spending time around people that are negative and aren’t thinking like you and they’re not inspiring you. People like that, energy vampires–
Dr. Justin Marchegiani: Yeah.
Evan Brand: If it’s really hateful music or really loud music and you’re constantly having to–there’s always that guy in the gym that has his headphones so loud you can hear him across the gym. That guy is depending on that music to get him through that workout, that’s a crutch. So I try to look at removing the negative inputs, too, before I even get to adding in the other beneficial supplements and things like that.
Dr. Justin Marchegiani: Yeah, I think one of the most important things is how you start your morning. There’s a book called the 6-minute Miracle Morning where the author talks about gratitude and visualization and affirmations. I’m always a huge fan of–I do a lot of Anthony Robbins 15 Minutes to Fulfillment where you get up and I’m gonna do it this afternoon today but you have 5 minutes of affirmation and–and tapping on certain meridian points that kind of prime the system. Number two, you go into a kind of a–a gratitude state. You really kind of gracious for all the things that you have and then the last 5 minutes you go into a visualization. So it’s–it’s affirmations, gratitude, and visualizations and that’s a great way to prime your system and really get all the beneficial hormones going in the right direction. So I–I think that’s a great way to start your morning off the bat for sure and reduce that negativity.
Evan Brand: Great. So supplement-wise and if this is not the direction you intend, interrupt me and shift me, but I think mentioning a couple helpful supplements for just general support would be a good idea. I really like a good vitamin C complex. Not just ascorbic acid, but getting multiple different forms of vitamin C and if you can do the whole food form, there’s a couple good brands out there that have some like derived from organic oranges vitamin C. That’s kinda cool. I just haven’t noticed that much supplementing it personally. But I think that’s kind of my first vitamin that–that I’d be safe giving a blanket recommendation for.
Dr. Justin Marchegiani: Yeah, I–we’re on the same exact page, so I’m gonna kind of go right into the diet stuff and dub tail that with the supplements. But off the bat, blood sugar or stress. Blood sugar instability is one of the biggest adrenal stressors on the body, right? We talk about what’s cortisol? It’s a glucocorticosteroid, right? The first part of glucocorticosteroid is gluco meaning blood sugar, so eating 4-5 hours is gonna be super important. If you have adrenal issues, if you’re stressed, don’t intermittent fast. Don’t–that’s putting a lot of stress on your system. Make sure you’re having a good protein and fat-based breakfast. Try to get, you know, your carbs from non-starchy sources or at least low-sugar fruit initially. That’s gonna be huge because that’s gonna take away your adrenals from having to pump out cortisol to bring that blood sugar up. Because again, if you eat too much sugar, what happens? You have this reactive hypoglycemic response. Blood sugar goes up like you do on the rollercoaster and then crashes down because your insulin sucks that blood sugar right down. And when that blood sugar is down and low, your adrenals are sitting there having to muster up adrenaline, norepinephrine, epinephrine, catecholamine, this is just the same–the same word for adrenalin 3 different times over, and then the cortisol as well to bring that blood sugar back up. So blood sugar is really important. Now on the blood sugar vein, we can use different supplements like chromium and alpha lipoic acid and vanadium and magnesium and cinnamon and gymnema and bitter melon and banaba. So these are different herbs and nutrients that we can use to help stabilize blood sugar. Again in the hierarchy, the diet part is gonna be the most important, the second will be the timing, and the third will be the supplements. So that’s a really good start off the bat. Next is, we’ll use a lot of precursors. We’ll use different building block precursors called pregnenolone or DHEA and we customize these according to the level of adrenal fatigue. So I recommend getting lab–if you’re gonna ever use a hormonal precursor, you wanna have your labs actually checked. You don’t wanna be supplementing any precursor stuff without labs. Number three, vitamin C is awesome. Again vitamin C, the reason why the–a lot of the Eskimos and the Inuit avoided scurvy, right? Scurvy is a disease of basically hemorrhaging of the various capillaries in the body because of lack of vitamin C and the–I think it was the British or the people over in the UK area, they were called limeys because they figured out when they would travel over from the UK to the US hundreds of years ago that people would die if they didn’t have vitamin C. So they found that if they just brought whole bunch of limes and ate these limes that they would avoid scurvy. So they got the–they got the term or the nickname limeys. So vitamin C is really important for that kind of health but again, the Inuit avoided scurvy because they would eat a lot of glandular tissue. So they would eat the adrenal glands of the mammals that they would kill and they got a lot of vitamin C from the adrenal glandular tissue because the adrenals love vitamin C. That’s why we add the vitamin C in our proto–programs or protocols so we support the adrenals. Also glandular tissue will have a little bit of vitamin C and also a lot of minerals and vitamins that are specific to the gland and then after that, our adaptogenic herbs which can help bring cortisol up or bring it down. It’s kind of a multitasker. It can downshift or upshift depending on where our stress is. And I know you’re a big adaptogen guy so I’ll toss the mic over to you and you can kinda give your 2 cents on that.
Evan Brand: Yeah, so there’s tons of different ones, but I recently just switched over per your recommendation and just to see what’s up. I was taking ashwagandha for a while which is a–a great adaptogen. You can take it in the morning for energy and endurance or you could take it in the evening to help sleep. It’s very unique like you just mentioned. But I just switched over to holy basil recently. I think it’s the Himalaya brand. They have a–an organic holy basil extract that’s pretty potent and I’ve been taking that and honestly I feel a little bit like Superman, like I feel invincible on holy basil compared to ashwagandha. Ashwagandha I just felt more calm energy. Holy basil, I feel like I just wanna pick a kettlebell up and just throw it like a shotput.
Dr. Justin Marchegiani: So does that mean we get to do the interview now with you wearing a cape?
Evan Brand: Maybe.
Dr. Justin Marchegiani: That’d be awesome. I would–I would like the big S on your shirt, maybe we’ll do a E for Evan with a cape.
Evan Brand: Yeah.
Dr. Justin Marchegiani: Love it.
Evan Brand: So maybe–maybe that wasn’t the most clinical explanation of–of adaptogens but my experience with them is that they’re very helpful. I think it’s kind of a 21st century necessity for people that have some type of adaptogenic support because we need to adapt–
Dr. Justin Marchegiani: 100%.
Evan Brand: To the environment. The environment’s changing. The climate is changing. Economics are changing. Job stress is changing. Gender roles are changing. I mean, I–I vacuum the floor. You know what I mean? I sweep the kitchen. You know, I have new roles that–that may not have previously been my roles like my Grandpa. He didn’t necessarily take care of in the home task, you know what I’m saying?
Dr. Justin Marchegiani: Yeah.
Evan Brand: It’s a tangent but I’m saying there’s so many new things that–that–
Dr. Justin Marchegiani: Uh-hmm.
Evan Brand: Men and women both are–are dealing with that they need some adaptogenic support. So I really think it’s been one of the most helpful things to keep me from derailing during building a business and all the stresses that come with being a, you know, a growing entrepreneur.
Dr. Justin Marchegiani: Right, and if you look at kind of Darwin’s theory of the survival of the fittest, really what he’s saying there in that theory is whoever can adapt the quickest and the fastest will be the most successful. So if we have stress coming in our lives, I think adaptogenic herb of some kind rotated in and out is a foundation in anyone’s life because we got stuff coming at us from the home with our kids and our family. We have work stuff. We have all–all of our play stuff we do on the weekends or on our free time and our exercise and our businesses and all these different things. We need to be able to adapt or even pivot, right? So a good adaptogenic herb helps one, modulate the immune system. Two, it helps support our hormones, right? Sex hormones like eleuthero helps with DHEA levels. Again, it can also help with libido and such, and two, it’s gonna help modulate our cortisol up and down. So if we’re in this place we’re anxious, we can knock it down; if we’re low and depressed, we can bring it back up. And certain herbs may be better for certain things. Like ashwagandha, maybe sleep and anxiety. Eleuthero for vitality, stamina, and exercise. Rhodiola for depression. Maca for libido and sexual performance. Tribulus for–for muscle mass. And the list goes on.
Evan Brand: What did you take today? Have you taken any adaptogens yet?
Dr. Justin Marchegiani: Evan, of course. So I had my little adaptogenic herb cabinet and I have all my herbs just kinda laid out and I just sit down. I go, “Hmm. How do I feel today?” And I just kind of, you know, use a little bit of intuition on what herb that I’m gonna use. But today was an ashwagandha day. Yesterday was an eleuthero and rhodiola day. And before that, it was a ginseng day. So I tend to pick things out depending on kind of my mood and whether I’m seeing patients or not, and I really need to be super, super hardcore focused and do a lot of listening, or if I’m with you and I’m gonna be kind of, you know, talkative and you know, connecting with you. So depends on what kind of stresses are I’m–I’m dealing with.
Evan Brand: So yesterday, you said yesterday was a rhodiola and what day? Did you have–
Dr. Justin Marchegiani: I think it was a rhodiola and eleuthero day.
Evan Brand: Okay, so I haven’t combined those two. I’ve used rhodiola and ashwagandha together and I love it. But I’ve never used a–eleuthero and rhodiola. What’s the–what’s the–the bonus effect there as opposed to taking rhodiola by itself. Well, I mean a lot of people like you said, they get a–fairydusted when they do a lot of these combos. They don’t get enough. So a lot of my patients, I’ll just recommend a really good combo product so they get the best of both worlds. They’re not taking a whole bunch of supplements. I mean, I’m a little crazy so I can have my 6 or 7 adaptogenic herbs. I mean, I couldn’t ask my patients to do that. If they want, they can always ask me and we can get them set up. But I like to have one or two that we rotate with patients or a good kind of a good broad spectrum one. So with myself, we kind of just–just have a whole bunch lined up and I kinda use my intuition based on what I know and based on my stress levels and how I slept the night before and what I’m gonna do and what I need. I think I side-stepped your question. Can you say it again?
Evan Brand: Yeah, the question was what do you feel when combining eleuthero with rhodiola as opposed to just rhodiola by itself?
Dr. Justin Marchegiani: You know what? That’s a really good question. I don’t know per se. I just know the various effects and profiles that these herbs have and there’s a lot of research that they work together synergistically. So for me, it’s more based on intuition. I wouldn’t be able to crystalize that for you.
Evan Brand: Right, and that–that’s totally what I expected. It is hard to feel. I just thought you may have noticed, “Ooh! When I add this to the cocktail, I feel an extra color enhancement or something like that.” I’ve had some crazy effects combining things. It’s kinda nice.
Dr. Justin Marchegiani: Yeah, I agree and I think everyone should be on some level of an adaptogenic herb depending on their stress. I think it’s super important. Everyone should be on a multi. A good quality fish oil if you’re not eating good–at least 4 servings or 4 ounces of fish a week. A good adaptogenic herb and then whatever other nutrients you’re missing based on your lab work people should be on as a–as a minimum kind of foundation in my opinion, and adrenal support is gonna be important because most people are stressed. They’re working more. They’re under more stress. They’re doing more and that’s kinda what’s happening in our society. Everyone is go, go, go, go, go, go. I mean our work week’s going up 10 hours, we’re sleeping less, so anything we can do to help us modulate and adapt to stress, we’re definitely better off.
Evan Brand: Yup. Well, that’s all I had in terms of today’s topic. I feel like we could go on tangents for another hour but I think that’s a great concise overview of this whole picture, the modern 21st century epidemic.
Dr. Justin Marchegiani: Yeah, and let me just kinda hit one thing home. The Russians in the 40s and 50s and 60s, they actually were doing a lot of research on adaptogenic herbs. They’re sitting there and they’re like, “Alright, like we want to have our athletes do better. We want out military to be better. We got this whole thing and the space race going on, what can we do?” And they spent tens of millions of dollars which back then probably, you know, equals hundreds of millions of dollars today on testing these herbs. I mean and they found that their military performed better, their athletes were better, they were using herbs to help recover. I mean, they’re probably using some steroids, too. But they were using some herbs that really helped recover from their workouts to modulate sex hormones, to improve immune function so after severe exercise or you know, mil–military mission so to speak, their immune systems wouldn’t be suppressed. So they did a lot of research and experimenting with these herbs and it’s like, “Man, if people really knew how powerful these things are, I think they would be part of everyone’s rotation if you will.”
Evan Brand: It’s life-changing.
Dr. Justin Marchegiani: Yeah, absolutely. Any take homes from you, Evan, here?
Evan Brand: No, just take a baby step from listening. I know there’s a lot of information thrown at you. So if there’s one lifestyle thing you can tweak, if there’s one supplementary thing you can tweak, if you can not skip that meal that you were thinking about skipping, go ahead and get you some good fat and protein, if there’s one little piece you can pull out of this podcast today and apply that, that’s gonna be helping to keep you in a normal rhythm and not become another burnout victim or maybe it’s the first step to try to help pull you out of that burnout that you’re in.
Dr. Justin Marchegiani: Totally agree. Again, my take home is make sure you’re getting to bed before 11 o’clock. Don’t skip breakfast. Eat every 4-5 hours, high quality anti-inflammatory protein, good quality fats, relat–you know, healthy carbohydrates for your metabolic type, right? If you’re doing a lot of exercise, you may need a little more carbs and again, find a good functional medicine practitioner if that’s helping a bit but it’s not getting you over the hump 100%, reach out to someone like myself or Evan so we can get some testing done and we can pull out the sniper rifle so to speak and get really specific versus, you know, just general run-of-the-mill adrenal protocols.
Evan Brand: Yup, definitely. Well, cool. Thanks! It’s been a blast.
Dr. Justin Marchegiani: Thanks, Evan.
Evan Brand: Alright, bye.
Dr. Justin Marchegiani: Bye.
Adrenal Fatigue and Leaky Gut – Heal the Adrenals and Help Heal the Gut
By Dr. Justin Marchegiani
Adrenal fatigue is a collection of signs and symptoms, known as a syndrome, that results when the adrenal glands function below the necessary level. Most commonly associated with intense or prolonged stress. Discover how these type of conditions are healed.
Today’s video is going to be on leaky gut and adrenal fatigue, and this is a topic really near and dear my heart.
I see dozens of patients every week with chronic gut issues, whether it’s ulcerative colitis, Crohn’s, autoimmune diseases, or the thyroid or other tissues of the body, bloating, gas, constipation. And there is one unifying principle with all those different conditions — that is inflammation.
Inflammation is this chronic breakdown of the body. So we have homeostasis where we have this constant building up and breaking down. That’s normal. It is life. That’s homeostasis. And with extra stress in our lives, conventional medicine calls it allostatic load. I just call it stress from physical, chemical, and emotional sources that will start causing our body to break down faster than you build up. So now we’re in this breaking down accelerated aging type of pattern. Again, anyone that has gone to their physician and they have been told, “Well, it’s all in your head,” or “You’re just getting older.” That’s what I’m talking about. It’s this inflammatory breakdown.
Dangers of Medications
In conventional medicine, the only option really is dangerous medications. Ibuprofen, Vioxx, Celebrex. Ibuprofen kills 20,000 people taken properly a year. Vioxx killed 60,000 in the early 2000’s according to all the released documents. We have Vicodin, Percocets. We have all of these Morphine-like compounds that are highly addictive, and then we have things like ibuprofen, Aleve, like I already mentioned. They actually drop down glutathione levels, too. So they’re going to decrease your liver’s ability to deal with stress and environmental toxins. Lots of options in the conventional community that don’t sound too pleasant and none of them really address the underlying cause.
When we talk about adrenal fatigue, it’s really important. We’re talking about functional imbalances. So I always tell patients, “Imagine health on a spectrum of 1 through 10.” 10 being optimal health, 1 being disease pathology. This is where you go into your doctor’s office and they’re like, “Whoa! You got this disease or that disease, or that-it is whatever.”
Imagine the functional imbalance is somewhere between 5 and 2. You’re not sick enough to be picked up by conventional lab work or conventional doctor’s visit. But again, you’re not feeling great enough where you’re motivated to be doing or you’re feeling worse enough so you’re motivated to be doing this lab work. People that are 7, 8, 9, they’re feeling pretty good. They’re probably not going to be motivated enough to dig in. So somewhere on that spectrum of 6 through 2 where my functional imbalances kind of live.
Most patients that think we talk about adrenal fatigue, we’re not talking about Addison’s disease which is a extreme low version of cortisol, but we’re talking about functional imbalances and one of the key functional imbalances here is HPA. Hypothalamus, pituitary–your brain–hypothalamus, pituitary, adrenal axis and this is what happens when we have chronic stress.
We have cortisol which is a stress hormone. Cortisol’s really, really important. It is glucocorticosteroid. Let’s break it down. Anytime you don’t understand a word. You just draw it out and you break it up because it makes so much more sense. Gluco–gluco meaning pertaining to blood glucose and energy.
Cortisol for Energy Production
So we have the energy side of the cortisol spectrum. We need energy for healthy energy. We’ll run cortisol rhythms on all my patients and typically cortisol is higher in the morning and it slopes down like a rollercoaster throughout the day. So cortisol’s there, it responds to sunlight. Right around 6 to 7 AM–6 to 7 AM in the morning, cortisol is really high and what we’ll see is if cortisol is low on that cortisol rhythm. Imagine here is the natural slope. If someone’s coming in here and they’re flatter, typically what we’re going to see are energy problems. We’re going to see massive energy issues in the morning if our cortisol’s lower. So we need cortisol for energy.
Mobilizing Blood Glucose
Cortisol mobilizes blood glucose.
Glucose then goes into the Kreb cycle and it spits out ATP. ATP is the currency for our body. Our mitochondrias need it.
Healthy Hormone Production
We need cortisol for healthy hormone production as well. If we’re too stressed and our body is burning up cortisol, one the biggest imbalances we see is lower progesterone in relationship to estrogen.
Typically we have about 23 to 25 times more progesterone than estrogen. But one of the starting points of PMS or any mood disorder is progesterone starts to drop and why does it drop? Because it’s actually going downhill to cortisol. So we need healthy cortisol balance. So it’s like Goldilocks. You don’t want the porridge too hot, you don’t want it too cold; holding that bar of soap, you grip it too, it squirts out; too loose, it falls out.
So if we’re too stressed, our progesterone goes downstream. Any woman that has PMS, this is one of the underlying driving factors. That’s why the cortisol being a glucocorticosteroid. And that’s why watching your blood sugar and eating healthy glycemic foods are important. Also, not eating extra refined sugar, maybe even avoiding fruits and starches that are too sweet as well, can be really important to helping to balance PMS. This is because progesterone will go downhill to cortisol. So you can see cortisol is really helpful for hormones. Not too much stress or we go estrogen-dominant.
Cortisol for Inflammation
So corticosteroid– a lot of people hear corticosteroids may be in their inhaler or corticosteroids for a cream to rub on an achy joint. Maybe even heard of a cortisone injection. These are really important. They are anti-inflammatory components. The problem when we expose joints or tissues to extra cortisol in medication form too long, it’s going to start breaking down ligaments, tendons, cartilage, soft tissue. That’s why if you go to an internist or an orthopedic person, they’re going to tell you, “I can only give you a couple of injections of this cortisone before it starts breaking down their tissue.” So they only can give you one or two shots.
Again, seeing lots of athletes–I see many of them say, “Well, I’m just going to get this injection,” and I tell them and I say, “You’re going to make the problem worse in the long run.” They come back in 3 to 6 months almost always and they’re feeling worse than they did in the first place. And that’s not the best situation to be in if we’re ignoring the underlying cause of a problem. So this is really important.
We always have to ask, Where does inflammation come from? The underlying cause. Well, what’s driving that? That is chronic pain. Do you have chronic back pain, neck pain, old surgeries, old injuries. This pain is going to drive extra cortisol. So it’s kind of like having a leak in the boat. Water is going to come in slowly. In other words, cortisol’s going to be leaking out slowly because of all this extra pain.
A lot of people ignore food allergens. Now this is really important when we’re dealing with leaky gut. This is because anytime you have extra intestinal symptoms (bloating, gas, fatigue, migraines), and you’re just not feeling good, almost always there’s going to be leaky gut in there. And if you’re eating gluten, you can almost always make the assumption there’s leaky gut.
Just for any new listeners here, leaky gut is nothing more than the gastrointestinal tight junctions. So really simple, take your fingers. Put them right together like this, hold them tight. This is your tight junctions here. This is the inside of your tummy where the food is. The outside here is where the blood is. Open your fingers up just a little bit and you can pop your fingers through, that’s like the undigested food particles going through into the bloodstream. And our immune system is not used to seeing all these undigested food particles and even bacteria like LPS, etc. So when these are in there, it’s stressing out our immune system. Anything that you eat frequently enough, you’re going to develop food allergens, too.
There’s the old expression, if you love it, rotate it. And part of healing from a healing gut is obviously cutting out all of the junky food and going on an autoimmune type of diet. No nuts, no seeds, no nightshades, tomatoes, potatoes, eggplants, peppers. Potentially even low FODMAPs and eggs. Say that 10 times fast, that’s quite a-leave your head spin in there.
But again, foods are so important and again it’s different for every person. Sometimes we have to cut off FODMAPs. Or maybe we have to be really strict on eggs. Sometimes we need more of a bone broth type of GAPs approach. At times we need to cut out salicylates or phenols. Again, it’s different for every person. So having a kind of a baseline template wherein you can customize is the best way to go.
Infections, a lot of people that have these chronic leaky gut, chronic stress in their tummies, well, their hydrochloric acid levels tend to drop. And that’s partly because they’re autonomic nervous system is favoring the sympathetic side.
So the sympathetic is the fight-or-flight mechanism and if you open up your Guyton’s physiology textbook, what you’re going to see there is the fight-or-flight mechanism. This is actually antagonistic for enzyme and hydrochloric acid production. Big fancy words, all it means is that you’re stressed, digestion goes down. That’s why the parasympathetic, that’s the opposite side of the sympathetic nervous system branch, is nicknamed the rest and digest.
Parasympathetic stimulates hydrochloric acid secretion. Hydrochloric acid’s the first domino that then activates the enzymes, the protein-digesting enzymes in our stomach such as pepsin and these help break down protein. The acidic chyme in our stomach then hits–it flows out into the small intestine and it hits the duodenum. This is where the bicarbonate is now secreted. The gallbladder then produces bile salts. The pancreas produces more protease and lipase, more digestion occurs, and then reabsorption in the colon.
What we need is a healthy domino reaction that has to form. We are in a sympathetic state because of inflammation, pain, allergens, chronic infections, emotions of feeling sick and tired. I almost always see that. That in and of itself is a major stress.
Again, pain, food, infections, managing emotions. There are good things you can do with meditation, just communicating about emotions. Also, there are different tapping techniques that you can do in such, very helpful to reducing that sympathetic amygdala type of brainstem sympathetic stress response.
A lot of people are exercising too much. I can’t tell you how many CrossFit patients I have. They’re just doing too much CrossFit. CrossFit’s a great modality especially when it’s ramped up for people in the right way at the right dosage in time. It’s going to be a modality. But some people are going at it too hard and they’re doing it too frequent. It’s causing their body to break down. And we’re making too much of this cortisol, too much of the corticosteroid side. Thus, we are becoming significantly inflamed.
So all of these things, if we have inflammation on one side, if we have energy issues on the other side. These are creating major, major problems and it’s setting us up for leaky gut. It’s setting us up. Now, the longer our gut’s leaky, the more we start losing tolerance to self, meaning our immune system’s getting exposed to all kinds of food, even bugs.
Lipopolysaccharide from the bacteria in our tummy is going into our bloodstream. It’s creating lots and lots of stress. And the longer we have our gut leaky, the greater chance we have of creating an autoimmune condition. There’s even a lot of research out there by Fasano, et al saying that it’s almost impossible to have an autoimmune condition without having a leaky gut. It’s like a prerequisite.
Treatment for Leaky Gut with the 5R Approach
So really simple, 5R approach is essential to healing the guts.
- Removing all of the bad foods is essential.
- Replacing enzymes and hydrochloric acid.
- When we repair, it’s adding extra nutrients to help soothe and heal the gut but we also need to be on an adrenal support. This is because the healthy cortisol from our adrenal glands helps put out the fire in our gut.
- Remove the infections. This tends to get mixed up. It tends to go first in a lot of doctor’s programs and people tend to have a healing crisis or a Herxheimer’s or die-off reaction.
- We put all of the good bacteria at the end. We don’t drop down seeds until we pull out the weeds. We remove the infections. It’s pulling out the weeds then reinoculating or dropping down the seeds. So, it’s weeds before seeds.
Again, this is Dr. Justin here, lots of great information. You may have to watch this video twice. If you have a chronic tummy issue, chronic fatigue, even a thyroid issue, 90% of thyroids are autoimmune in nature, this information has to be applied to your health plan for you to get better.
If you have any questions or you want to reach out and start taking the right step to heal, click onscreen or click below. I look forward to helping you out.