Adrenal fatigue - Wired & Tired Always

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Aap apna video— sorry, audio of Raklu. So, very, uh, good evening. A very good evening to all of you. I am Dr. Ruhi, founder of Functional Medicine Clinic, and on behalf of Functional Medicine Society of India, I welcome all of you to today's session, which is on adrenal fatigue. So as we know, when our body is exposed to stress, our adrenals help us cope with it, but chronic stress leads to adrenal burnout, and eventually our body is no longer able to help us coping with the stress. And we feel, we experience symptoms like anxiety, difficulty falling asleep, craving for salt, can also be craving for sugar, and much more. So today we have an expert with us to enlighten us more on this topic. I welcome Dr. Preeti Nanda Sibal. She has more than 25 years of experience in wellness, health, and fitness domain. She is an entrepreneur, a motivational speaker, a functional medicine practitioner. She is the author of, um, Cyclic Keto, and, uh, her focus areas are diabetes, obesity, and gut health. I can go on, but I'll have to stop here, and, uh, I will hand over to Dr. Preeti. So, Dr. Preeti, welcome today, and it's all yours now.

Thank you, Dr. Ruhi. And before you, you know, give me everything, you have to give me the share screen rights. Thank you. So very, very good evening to everyone. And so the goal today, for me at least, is that we all know what is adrenal fatigue. I know, but I have been working in this space for last 2 years now, and I have seen amazing benefits to patients When, you know, we are able to diagnose the right thing. And I will share with you exactly that. So that, you know, you can find something new in this and, you know, maybe we can benefit our patients more. So, Ruhi, is my screen—

Yes, you can. I have allowed you. I have made you the host, so you can share your screen.

But my— you can't see my screen right now?

Not yet.

Okay, perfect. So now my screen is visible? Yeah, perfect. So good evening everybody, and remember, I am not going to talk continuously. I get energy from people, I get energy from questions. And I believe the more you interact, the more you remember. So are you ready for an interactive session? If you are, give me a thumbs up in the chat box. So we have 7 participants currently, so I need 6 thumbs ups at least. Thank you, Amit. Thank you, Ruhi. Thanks, Charlene. 3 more to go. So I know who all have logged in and are not listening to what we are talking. Dr. Tang. Okay, Dr. Tang has also given a thumbs up on his screen. Great. Thank you. So the topic for us, you know, which we are going to talk about today is adrenal fatigue. So let's look at some pictures. And before I come to some pictures, like Ruhie has already introduced me, and this is what this slide talks about. I do some online group programs so that functional medicine can reach out to masses. There are this anti-aging program which is titled Young at 100, so that you reverse all your diseases and, you know, live a healthy life. We have a program around type 2 diabetes which is just a 9-day program to tell you about your lifestyle and correct it, and we've seen phenomenal results in just 9 days. Type 1 diabetes program. I have a program on adrenal fatigue which is for 14 days, a gut health program, For our rapid fat loss method program and become a superwoman program. So this is what we do in groups. So let's look at some of the pictures and tell me what comes to your mind when you look at this picture. You can unmute yourself and speak, or you can write in the chat box, whatever you think is better. This picture ko dekhe kya? What is it that you are wanting to— you know, what is coming to your mind?

Exhausted.

Exhausted, yes. What else?

So Amit says exhausted, Siddharth says overstressed, irritated.

So this is, you know, I've written it down also. Increased premenstrual symptoms, bloated, tired, feeling crappy, cramping, craving for chocolates. Doctor and doctor. No. And the thought in your mind comes, does it get any worse than this? So what is this? This is a picture from the book by Wilson Geil, Adrenal Fatigue: The 21st Century Stress Syndrome. What is this? Either drinks or cold drinks or more caffeine, tea, coffee, just so that you can go throughout the day and do your regular course. And this, what does this picture tell you? Please mute yourself if you are on the road. Yes, what does this picture tell you? Even when you are out for fun and you are dancing and that's the best thing you want to do, you crash. Which tells you that you have reached a stage where you can't even do things which you love to do. And this is exactly what you feel at that moment. Your everyday tasks actually become a death sentence. It looks like you are dragging this weight, 100 lbs weight, with you all the time. So whose story is this? Can anybody guess? Shalini says, I have been here. Anybody who can guess whose story is this? Almost everyone. Siddharth says almost everyone. So, at least for doctors, this is very, very common. And I don't know whether you have noticed this or not. Typically, people with Type A personality, people like me, you know, you are— who are go-getters, who are full of energy, who think they can do anything, whatever they want to do and think they can do, without realizing the fact that they will have to compensate for that at some point of time. And the earlier they do it, the better it is. So let me tell you, I got married at 21 and a half years of age, just out of medical college, and I had two— and I have two beautiful sons who were born, you know, before I was 25. So I celebrated my 25th birthday with both of them. And of course, raising kids in a nuclear family, we all know how stressful that can get. But to top on that, I was working and I moved on to corporate jobs. 16 hours a day, 14 hours a day was my routine. Every 15 days, international flight, and every weekend, Indian flight to a different city, right? And I used to enjoy that, and I used to feel, wow, such awesome lifestyle, this is wonderful. And then what happened was the number of diseases I was suffering went on increasing. I became an asthmatic, a hypothyroid patient, I used to have migraines, I became obese, backache, cervical, and then diabetic. But despite this journey of adding, you know, of this 25 years, and every few years I used to have a new disease. Never did it strike me that I should check whether I am in adrenal fatigue or not. I used to feel very good saying I can have— I have 12-14 cups of tea or coffee every day, but I am very, very energetic, a typical Type A person. But what happened was, 5 years back when I came into functional medicine, And reversed my diabetes, reversed my thyroidism, reversed my migraine, everything. Despite that, my memory was not getting better. I used to feel tired. The whole day used to be great. I could do full-day workshops, but after that, I had to rest for 2 to 3 days before I could come back to my normal energetic self. Now, nobody in the outside world could see those resting days which I had to struggle with. But for me, every workshop, every few months, this was getting difficult. And to top on that, I was to appear for exams at A4M. That meant studying for 4 to 6 hours every day in addition to work. I can't tell you In what plight I gave my exams, and I gave both my written and oral in the same go, in the same visit to US last December, and everybody was shocked. But I am like I am. I want to do always more than what people should be doing. But when I came back to India this January, I had no energy to do anything. And suddenly, you know, it popped in my mind that I understand that we don't talk about adrenal fatigue, but how about getting my cortisol levels checked? My— I knew I was progesterone deficient and I got it checked, friends, and you won't believe, after treating— I don't have my old reports, but after treating myself for 3 months, my morning cortisol was 11.6. And I continued working on my adrenal fatigue, and I am even now working on my adrenal fatigue. I've slowed my lifestyle a little. I've changed the way I exercise, and I will share with you today everything what I did for myself, because that is what I do for all my patients now. So Has anything struck you or has something opened up for you while I was narrating my story? If something has opened up for you, please write in the chat box what has opened up for you. I also forgot to tell you that it had become very easy for me to cry on anything, and I used to get really angry and upset with my friends, with my family members, for almost no reason. When I look back today, I think I had no reason, but my adrenal fatigue was making me do all of that. Anything which came up in your mind while I was sharing my story with you? So So before we move forward, I am sharing a link in the chat box. Please click on this link and just do this questionnaire. It will take 2 minutes, but I think it's important. Right, Siddharth? So I think we guys are lucky that at least we have found out what's the problem and are working on it. So friends, for all of you, you— I have put a link in the chat box. Please open the link and try and do that questionnaire. It is for your awareness. Where are you today? Perfect. So hope you guys have opened it. So let's understand something about adrenal hormones, especially cortisol, which is the most relevant hormone, and I think this is the hormone which decides whether we are living our life or not, right? So it has anti-inflammatory action, it decreases antibody production. So any patient of autoimmunity, we must look at the adrenals for them. It suppresses release of growth hormone. So high cortisol would mean low growth hormone. Bone loss, increased gastric acid production, inhibits production of nucleic acids and mobilizes fatty acids. So if I have to, you know, sum the functions of cortisol which are more relevant for us, it normalizes blood sugar. Cortisol and insulin are like sisters and they affect each other very significantly. Immune system suppression, anti-inflammatory action, and vasoconstriction. Now this is very, very important, friends. I think at some point in our lives we forgot this. At least I did. I used to feel very good when I used to sleep at 3 or 4 in the morning, and I think that's what led me into the state of adrenal fatigue, phase 1. So this is how the cortisol rhythm changes, and therefore our cortisol levels are very, very specific to the time we checked it. Cortisol is at its highest 1 to 2 hours after, you know, the sun rises, about 7-8 AM, and it starts declining post 12 PM. And knowing cortisol levels at 8 AM, 12 PM, 4 PM, and 8 PM helps us to understand how internally our body is functioning. And cortisol levels, yes, they shift, but do you think stress impacts or cortisol levels impact us? The president of the American Institute of Stress said, we are left with what every complete physician eventually learns, namely that many times it is much more important to know what kind of patient has the disease than what kind of disease the patient has. Especially in adrenal fatigue, it couldn't be much truer than otherwise. So again, American Institute of Stress did a survey and found that 75 to 90% of all visits to primary care physicians are for stress-related problems. And of course, 19% of absenteeism, 40% of job turnover, 10% of cost of prescription of drugs, and 60% of workers' compensation awards are because of stress. And this is from a book, Ravi Tungri, which Ravi Tungri has written, What Stress Causes. So let's look at how does our cortisol circadian rhythm or levels change. How many of you experience these things during their day or their week or their months? Please give me a yes or no in the chat box. Yes, Siddharth, feeling tired after exercise is also a symptom of this, and I will talk about it more in my coming slides. How many of you can relate to any one of these? I can relate to a lot of these, but how many of you, you can relate to? Popping pills, drinking sodas and all, using toxic cosmetics, living in a polluted city, eating junk food, or having too much of work. And it's very difficult to define too much of work. So what could be stressors? Anger, depression, fear, guilt, chronic fatigue, and other illnesses, infections, chronic pain, excessive exercise— please note it— gluten intolerance, low blood sugar, malabsorption or maldigestion, overexposure to toxins and heavy metals, chronic stress, toxic relationships is included there. Any surgery, overwork, keeping late hours, sleep deprivation, excessive sugar consumption or excessive caffeine intake, chronically infected root canal or poor oral health, viruses and chronic subclinical infections, and I can go on and on and on. And these stresses actually lead to what we call as allostatic load. And the moment this allostatic load increases, which is perceived stress— so basically, friends, we all know situation is not stress, our response to that situation is stress. If you don't have clients this month and you are happy thinking, wow, fine, I will have them next month and let me chill this month, it's as it is very cold, right? So it will not be stress. But if you keep thinking the whole day how will you get that revenue or those patients whom you are desperate to help and help them live a happy and healthy life, it will become stress. Any trauma, any abuse, everything depends on how you perceive it. And if you are not able to change that stress perception to adaptation, and be comfortable with it, it will increase your allostatic load, which will result in shifting your diurnal cortisol rhythm, right? So what will happen? Stress hormones, it will start tweaking your thing, and the time for physical repair and then the psychological repair will continue to decrease. So what all symptoms you think this will result in? I think all of you know a lot of them, but I will just point out some very, very important ones which I did not know before I started working in this area. Lot of allergies, food allergies and also, please, if you have a patient of allergy, gluten allergy, lactose intolerance, food allergies, sneezings, do look at their adrenal status. Dry and thin skin, if you have patients with hypoglycemia, low blood body temperature, low blood pressure, unexplained hair loss, please check adrenals. Any gut symptoms, adrenals and gut health are completely related. So if any one of you feels that you want to work on gut health of your own yourself or of your patients, do check your adrenals. If you, if you find it difficult to sleep at night or get up in the morning between 3 and 4, check the adrenals. Cravings for salty food, high protein foods such as meat and cheese, please. For women, your irregular menstrual bleeding, we of course know it is because of estrogen dominance and low progesterone. But that comes from where? It comes from adrenals, right? Hypothyroidism, friends, and I want to tell you here very, very categorically in inverted quotes, if you get a hypothyroid patient and the history tells you that there is adrenal fatigue, before you work on the thyroid, please work on the adrenals for 2 weeks. Don't start working on thyroid immediately, and you will see in the coming slides why I am saying this. Tendency to feel better on vacation. So let me tell you, you know, 3 years back, so since I've come in functional medicine, we've made as a policy during our anniversary, we go for 9 to 15 days to a place where we learn yoga, or, you know, we do meditation or relax. So I remember 3 years back, we were in a place near Dharamshala where, you know, we had a hut on a treetop, exactly the way I used to dream when I was a young girl. And for the first 2, 2 and a half days, my body just was recouping, just was feeling as if, you know, I've been drained so so much. And I told my husband after 3 days that now I think I can do yoga and I can, you know, go out for walks and enjoy the weather. I just slept for 2-3 days. Imagine how deprived my body was, and unfortunately I was doing nothing about it, right? So very, very important. So friends, in addition, whenever we're talking about adrenals, you know, we We want to remember just a simple fact that adrenal medulla, which is the inside, releases epinephrine and norepinephrine, which helps us during stress, and adrenal cortex releases aldosterone, cortisol, and androgens pregnenolone and progesterone. Now why this is important is that we need to remember that when cortisol levels shift especially when they become low, aldosterone also shifts, and therefore you will see these patients have salt cravings. And therefore it becomes very relevant that we give them, you know, sea salt early morning so that they can recoup their energy and use less of epinephrine or epinephrine to do their functions. I've put this picture just to tell you These very little adrenal glands, which are very, very small in size, play a huge, huge, huge, huge role in our well-being. Please mute yourself. Huge role in our well-being, and we must not ignore them, especially in today's lifestyle. Right? That is the time when adrenals should really be focused on and we should do everything possible to support them so that they can support us live a very happy and a regenerated life. We have less time today, but still I have put this slide here because I really want us to know that our brain manages a lot of things. Right? And from the HPA axis, we, you know, lead to cortisol, and from the AHS axis, epinephrine and adrenaline. Norepinephrine is released first, and therefore, the moment cortisol decreases, for some time mental alertness is managed, but after that, your mental alertness goes down. I very categorically remember, after seeing two 2 patients, I always wanted a break because it was very difficult for me to do the third report, right? Thankfully, I can now do continuous work for as many hours as I want. But so let's look at what are the stages of adrenal exhaustion. Stage 1, Stage 2, we generally don't realize. Stage 3 is where symptoms really keep coming back to us more frequently. And keeps knocking on our door, do something, help me, help me, help me. But still, I think a lot of us, because of unawareness, are not taking account of that. Let's prioritize and let's please make sure that we actually respect, love our adrenals so that, you know, we love ourselves. So this happens initially in stage 1 and 2, The cortisol levels increase, the DHEA levels slightly decrease, and in between they also can increase between stage 2 and 3. That's what I've seen in my practice. And then if in stage 1 and 2 we don't take care of our adrenals, the adrenals say, you are not bothered, why should I be bothered? Let him live a compromised life, or let her live a compromised life. Life, and they give it up. They say, "Meri pas itna hai paani tha, itna hai pila sakta tha, mera glass ho gaya khaali." Right? And that's what is happening to lot of us these days. And this is where it happens, and then we go into failure. But generally, this here in stage 3, it actually comes up with lots and lots of symptoms. People keep going from one doctor to another without finding finding the right result. So I think it's a lot of responsibility on all of us who are here today that we understand this better and give the benefit to our patients. So what is it happens if cortisol levels increase and what is it happens if corticoid levels are decreased? So chronic diseases, anorexia nervosa, OCD, panic disorder, Difficulty in exercising, malnutrition, diabetes, hypothyroidism, central obesity, abuse, pregnancy— all of this leads to high cortisol. Decreased cortisol levels lead to atypical depression, seasonal depression, chronic fatigue syndrome, fibromyalgia, hypothyroidism, adrenal suppression. Rheumatoid arthritis patients do check their adrenals. Autoimmune disorders, please check their adrenals. I am going to skip some of these because we have to rush, but adrenal dysfunction can affect these organs: immune system, reproductive system, parasympathetic nervous system, cardiovascular system, endocrine, and central nervous system. So if you have patients of any of these disorders, do remember adrenal dysfunction is in the center. So let— I've put some, you know, reports for you to visualize how it looks. So if your cortisol is in the green zone, we are good. And if your DHA is in the green zone, we are happy. So if you see here, the DHA is slightly less than the center, and we like DHA to be in the upper half of the level, but otherwise this is a good report. Look at this. DHEA, they've not been able to measure, and cortisol is so high at all the timings. So the cortisol is just messed up. It's between stage 2 and stage 3, and We really need to do something about it. Now this is a typical cortisol graph which I find in my patients when they come to me. Morning cortisol is low, body is not— adrenals are not able to work so much, and when they should be low, it is high. And then comes the flat line of the cortisol. So what happens when there is flattening of cortisol? Inflammation will increase, so IL-6 levels will be more. You will have more fatigue and all the symptoms which I talked about in the beginning. So friends, here I want to emphasize that this triad is very important to have in mind: brain, immune system, and your gut. And there is another triad I want to just, you know, create awareness around is ovaries, adrenals, and thyroid. This triad, so ovaries, adrenals, and thyroid, or your reproductive organs, your adrenals, and your thyroid, they're very, very closely related. And when I say adrenals, it would include cortisol and it would to some extent also include insulin. Because cortisol impacts insulin dramatically, right? And I know I can go, I can have a special class on otexis, but maybe sometime later. Now what happens is when this stage continues, stage 3, hippocampus starts reducing, neurodegeneration starts happening, and the centers like amygdala, locus coeruleus, start getting involved, and therefore cognitive decline and memory loss starts happening. This is a very, very beautiful slide. I know this needs more time, but still, quickly let me share with you what happens when cortisol shifts. Inflammation, stress, and anxiety. 2 main things which happen. TNF-alpha increases, all inflammatory markers increase, and it leads to heart disease, diabetes, inflammation, Alzheimer's, thyroid disorders, cancer, autoimmune, neurological. So there are studies to show that flattened cortisol rhythms are seen in patients with metastatic breast cancer. Hypocorticism and interleukin-6 is— see, increased IL-6 is seen in breast cancer patients. And now this is another report, you know, this patient came to me, the name has been changed, 59 years with the complaint that I don't like to exercise, I feel depressed, I'm not able to lose weight. And please do something about me, for me, because life is not worth living. And in 6 months, friends, his cortisol levels were normal, his DR levels were normal, and his sleep had improved dramatically. And he's much better than what he was before. So friends, how it goes, though we have seen it in images, allostatic load increases, which leads to HPA axis dysfunction, which leads to cortisol excess, and which leads to cortisol deficiency. We only have 10 minutes. I'm going to wrap this up quickly. So important things on what— how to treat these patients. There are a lot of supplements which can be given: vitamin C, B, D, E, 5-HTP, L-theanine, rhodiola, magnesium, zinc, selenium, copper. First level. If these don't help, we can give them steroids for some time to just help them sustain their functions. We have to manage their sleep. We can do that by melatonin, L-theanine, 5-HTP, GABA, and lot of other herbs which we can maybe talk in a next session or sometime later. Exercise. For all patients who come to me with low cortisol, I tell them to stop exercising. Siddharth, this is especially for you. So when I say stop exercising, I tell them to move to pranayams. I tell them to do abdominal deep breathing to stimulate their parasympathetics. I tell them to do laughter yoga, extremely beneficial for your adrenals. And maybe we can have a class of laughter yoga also once in one of our sessions. And when it comes to diet, 50 to 60%, I generally give them raw foods. I tell them to sprinkle sea salt liberally on their food. Foods with high in potassium are Avoided like bananas, dried figs, raisins, dates. I don't allow them to do 16 hours fasting. Maximum fasting they're allowed to do is 11 to 12 hours. Breakfast before 10 AM is mandatory. I tell them to eat fruits just before meals, not separately, because it could spike their insulin levels. If they find it's difficult to sleep at night, generally my go-to is eat some protein and fats such as nuts or chicken or eggs before retiring, or coconut oil. It really helps you get good sleep. Avoiding foods which cause inflammation like wheat, like dairy, really helps. And friends, it's very important for you to understand which is the main organ which is disturbed. Is it the reproductive thing? Is it the thyroid? Is it the adrenals? Because your diet protocol and your exercise protocol will change accordingly. Avoid eating fruits and vegetables in the same meal, starch and protein in the same meal. Check for betaine, it's very important. And do add probiotics and digestive enzymes. Lactobacillus acidophilus, Bifidobacterium, these are the ones which are very, very good, and I really support them and use them with my patients nicely. Thank you. I am open for questions. Sorry I hurried in the end because I wanted some time with you to answer your questions.

Yes.

Thank you, Dr. Preeti. That was really good and informative, and I'm sure we need a second part of this session. Um, so, uh, questions anyone?

Um, doctor, what's your take on anxiety from adrenal fatigue?

Huge, huge anxiety from adrenal fatigue. All the patients who come to me are anxious. In fact, I used to be very anxious. The moment there used to be something which was difficult for me or which needed multitasking, my heartbeat used to increase. And at times, you know, when I was not able to fulfill that, I actually used to start crying and I couldn't control it. And for a woman who's never cried, who has handled teams of 4,000 people at one point of time, you know, who's won so many awards. It was, it was so difficult for me to understand that. So anxiety is definitely there in low cortisol patients. And very good question, thank you.

Thank you, Dr. Mai. I'm, I'm, I'm, I'm wanting to do more because melatonin is a good supplement, magnesium, selenium, iron, and And, and we, you know, I'm sure you must have seen patients where you've put them on all the required supplements, you've tested them for neurotransmitters, everything is looking under control, they still have that anxiety symptoms.

Check for toxins. What happens is, okay, so this is something which I want to actually reiterate, is sometimes giving all supplements can be a deterrent in healing the patient than an add-on. Because we have to always remember and know what is the metabolism of the body, how much the body is ready to take. See, if for a layperson I have to explain what is low cortisol, it would be— our body always knows what is best for us. Yes or no?

Yes.

Yes. And our body has a perfect mechanism. The more I study functional medicine, the more I treat patients with functional medicine, I am more in wow for the human body, the way it has been created, right?

Exactly.

When we are in low cortisol, what happens is our bodies compromise on all the functions of our body. For example, last year, you know, I— for last 2-3 years, what used to happen was my liver and kidney functions were at their lowest. And everybody who used to test me and everybody whom I used to show my report, I used to ask them, Why is it so? I'm so active, I'm energetic, I keep running, I play, all of that. Nobody had an answer, but now I have an answer for that, and I'm very confident in April when I get myself tested, my liver and my kidney functions would be optimum. Because low cortisol means everything from your intestinal motility Everything, the body will slow down. Because body knows that ya pe bhaiye kame, mujhe bachake rakna, I have to save for the rainy day. Yes. Right, so when this is the situation, if we give lot of supplements, right? The body cannot activate all the organs in one go.

The thing, doctor, is I never put my patients on all the supplements, but fortunately, unfortunately, all the people who find functional medicine practitioners and come are already on a truckload of supplements, right?

So you decrease them.

I, I, in fact, I, I only kept to the bare minimum and stopped her for 2 weeks. But, um, you know what happened is they are so anxious even in stopping it. You know, it's like the cat on the wall. They're so skeptical in stopping it.

They—

so they want that— especially anxiety, adrenal fatigue, anxiety patient, they want They want that one magic pill where they don't feel like that in the head, right?

So you know what, uh, I have seen 80% of my patients' anxiety gets better, and I have proven them by checking their heart rate variability and other stuff when I make them go completely gluten and dairy free. And please remember, when you tell your patients to go dairy free, make sure that they leave that tea also with milk. Because that one cup of tea, I have seen in my practice, screws up the whole thing. I had a psoriatic patient with very, very bad situation, and I do an elimination diet group program. Okay, right. So, so that, you know, a lot of people can come there, and you know, you have similar type of patients, so you get the energy to do it. Every group, I find 2-3 people who've been gluten-free, dairy-free for over a year. But they have been taking that one cup of tea and seeing no relief in their anxiety. The moment they get that off for 3 weeks, their anxiety goes off completely. If you want to visit my YouTube channel, which is Food, Medicine, and Lies, see some testimonials there. Our body never stops to amaze us, at least not me.

Agreed, agreed, doctor. In fact, to, to, to give you all the credit, until she came to me, she was on that dairy. And then even after she came to me, she cheats on that 1 cup of tea. But last time I told her, put my foot down and said no, no, that 1 cup of tea, even that bit of milk is equivalent to poison. You cannot take it. So I'm expecting her to change that graph probably maybe in a week or 2 weeks' time. But I think maybe you came in at the right time.

Thank you. Maybe you can try something different. So I never say no, uh, to my patients because I think adding good things actually eliminates the bad things. So what I do in that one week is they have a challenge to try and post different types of teas and coffees and drinks, substitute their morning tea. And that is the reason my program is wowed for that people leave their morning teas in my program very successfully. So that's one thing I've achieved in the last 5 years very successfully.

I give them alternate herbal teas and all of that.

But, you know, then coconut milk coffee. Tell them to go to Starbucks and drink almond milk coffee. Yeah, but then they start liking it. You know, the environment matters. Yes, and I'm sure you're doing all of that. So, um, anytime you have a question, do drop me a message and I will definitely be happy to answer if I can. Thank you. Thank you, and thanks for being a part of this.

Thank you.

I think we can take one more question if somebody has, and then We will close. Any questions?

Yeah, Dr. Preeti, I'll ask a question. So what's your take on, you know, that like we do the blood work for testing the adrenal function versus the salivary test, right? So I mean, not the salivary test is not available, available everywhere. So what, what's your take on that?

So my take is that at least if I can do salivary and blood for patients in the first time, I'm happy, right? Because it gives me a good connection. But even if blood— if I can get 3 samples or 4 samples, I repeat those tests every 6 weeks or 2 months, and that's been faring me well. In adrenal fatigue, one thing which is helping me, Ruhi, is history. History and history. You, you do the test only to realize how deep you have to go. Otherwise, you know, history tells you everything.

Absolutely. Yeah, right.

But it's a very good question because in India, because of lack of— though now people are doing salivary cortisol in India also, but honestly don't know the reliability, have not done their test a lot. So blood test can fare you well. Also DAS. So DAS with that, your B12, and these with that, your thyroid, your insulin. And so DAS, cortisol 3 to 4 times, thyroid, insulin, T, B12, and your hemogram. If you do these together, even blood work is good. Thank you, and thank you for your patient hearing. And we'll be happy to answer your questions anytime later also, and hope something was added to the way you look at adrenal fatigue patients today.

I'm sure, Dr. Preeti, everybody has benefited from the session. Myself, I can definitely say I have. And as I said, we will have— we'll need to have a second part of the session, right? So that we can learn more on this. And with that, let's say bye to all of them and thank you. Thank you, Dr. Preeti.

Thank you, Ruhi, for having me here. Thank you very much.

Thank you.