Tired And Wired: How To Heal Adrenal Fatigue with Dr. Izabella Wentz

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Welcome to the Doctor's Pharmacy. I'm Dr. Mark Hyman. That's Pharmacy Within FAPhA Place for Conversations that Matter. And if you've ever struggled with fatigue or feel burnt out or feel overstressed or tired and wired when you go to bed and you don't know why, well, you're going to find out why today because we're going to have an amazing conversation with Isabella Wentz, who's a an acclaimed thyroid specialist, a licensed pharmacist who's basically dedicated career to addressing the root causes of autoimmune thyroid issues after being diagnosed with Hashimoto's in 2009. And she's also focused on this issue of burnout and adrenal issues, which is what we're going to talk about today. She's the author of three books on Hashimoto's, Hashimoto's Thyroiditis: Lifestyle Interventions for Finding and Treating the Root Cause, Hashimoto's Food Pharmacology, and the Hashimoto's Protocol, which became a number one New York Times bestseller which is no small fee. So now her new book is come out. It's called the Adrenal Transformation Protocol. And I think in our overstressed world, we all need it right now. So go get a copy right now and then listen to this podcast, 'cause you're gonna hear us unpack what's in the book and give you a sense of how to heal from chronic stress and fatigue. So welcome, Isabella.

Thank you so much for having me. It's a pleasure to be here with you.

Okay, well we both know the reality of overdoing, overworking, overgiving, over stressing, and being burnt out. I'm a doctor, you're a pharmacist. We both went through hazing, which is all our training. And, you know, I clearly people who go into the helping professions, maybe a little codependent, I certainly was, and tend to just burnout. And there's such a massive amount of burnout in healthcare, but it's also burnout in our whole society. We're constantly stimulated by stressors, whether it's, you know, work, family, money, you know, our environment, the climate change stresses, the political environment. It's just, the list goes on and on. So I think more than ever in history, we're just bombarded and it gets worse and worse. So I'd like you to start by sharing your story of burnout. I ended up having chronic fatigue after working the emergency room multiple shifts, trying to raise a family, going through divorce, and it was just a disaster. And I understood what it's like to have my adrenals just completely crap out and had to recover from that. And I want to hear your story because I think it's an important thing to start with. And then we're gonna get into what is adrenal burnout? Why doesn't the traditional medical establishment consider this a thing? and it's completely ignored. And why are most people not getting access to that kind of treatment and care they need to actually restore their vitality and energy?

Wow, yeah, I feel like as professional healthcare professionals, we go through intense training and there's so many exams that we have to do and wake up super early and then you stay up the night before and cram. And so I personally think that my fatigue issues really started in college. probably in my first year in college. And I was taking like chemistry, biology, and physics, and I was doing the whole major of that. And then also, I thought it'd be really fun to stay out all night to like go to the bars, right? So all the things you do when you're 18 years old and maybe your brain's not fully formed yet. And so my issues with fatigue actually started with my first year in college. And I went from this really bubbly and bright-eyed and bushy-tailed person that started college to all of a sudden sleeping through my exams, right? So I slept through one of my final exams, as you can imagine, being a Taipei person. I was like, oh my gosh, why did I sleep through my exam? And I had laid down the day before at like 3:00 to 4:00 p.m. to just take a nap. And then following morning, my exam was supposed to start at 7:00 a.m. And I ran into the exam room at 8:00 a.m. Because I had just woken up. And I was on this journey of like, you,'re always so tired. Why are you so lazy? Right? I had to eventually come up with accommodations to make up for my fatigue so I could study. And I kind of figured out during my second year in undergrad. by pharmacy school, I just really had a system where I just really learned how to be very efficient in studying and getting things done and very productive in the time with the little energy that I did have. But I did require like 12 hours of sleep a night. And I was just like, you know, I'd wake up tired. I'd be tired all day. And I had to drink like six cups of caffeine to get myself get like you know, get my brain working and get myself through the day. Finally, I was diagnosed with Hashimoto's after becoming a pharmacist and I went to some conference and it was like, oh, you're not supposed to sleep 12 hours a night. And I was like, huh, is that interesting? Finally pursued additional testing. The Hashimoto's diagnosis came. I was like, this is amazing. Finally going to get on some medications to help me. The medications helped a little bit. So I went from sleeping like 12 hours a night to 11 hours a night. I was grateful for that, right? That helped. And then also, but I still had the fatigue and I still had all these digestive symptoms and acid reflux and IBS. And so I went through a process of really discovering how to get back my own health. And part of that was the gluten-free dairy-free diet. Your books were life-changing for me. I was reading them when I was listening to audiobooks on my way to work. and getting off of those foods helped me get rid of the acid reflux. But then I still had the brain fog and the fatigue, and somebody brought up adrenal fatigue, and I was like, well, this, I Googled it and this was 10 plus years ago. I'm like, this doesn't exist. It's like, you know, clearly this reputable site says it's not a thing, so I just kind of went on and looked for other things, and finally the 15th person brought up adrenal fatigue, and I was like, oh, Okay, well, maybe this is a thing because I have all the symptoms and I tried the interventions and I got better. Holy cow, my brain works. I'm waking up early in the morning. I don't need 11 hours of sleep. I'm sleeping eight to nine hours, waking up refreshed. I don't have that anxiety. I don't have the panic attacks. I'm not hangry anymore. I'm sleeping and it's a refreshing type of sleep. And so that was over 10 years ago and that was part of my healing journey where I was like, wow, I feel like myself again. Turns out I'm actually a calm and relaxed and happy person. I'm not anxious and exhausted all the time, right?

Yeah, powerful. So let's talk then about what actually happens. What is going on with this phenomenon of adrenal burnout or adrenal exhaustion? Because in traditional medicine, how I was trained, there's something called Addison's disease, which actually President Kennedy had. which is basically adrenal failure, where your adrenal glands can't make cortisol, they can't make the mineral corticoids that keep your blood pressure up. They really stop working properly and it's an autoimmune disease of the adrenals. Now, there are some other adrenal conditions that have also problematic, but as a whole, the medical profession doesn't even understand this, doesn't diagnose it and doesn't know how to treat it. and yet most of us are pretty stressed out and feel it. And there's a wonderful article in the New England Journal of Medicine a number of years ago by Bruce McEwen about stress and the effects of chronic stress. And he really mapped out using very rigorous science what happens over time as we start to get stressed and our bodies respond with high cortisol and then eventually burn out. And then we can't produce enough of the stress hormones when we actually are stress and we just feel exhausted. So can you talk about this sort of ancient system that allows us to kind of respond to stress, but how our modern life keeps us in a state of chronic stress and survival mode, which ultimately leads to our adrenal dysfunction? So talk about how that works and what are the symptoms? How do people know if they have this?

Absolutely. And I know that the term adrenal fatigue, maybe it's not like scientifically accurate. There was a naturopathic doctor that coined the term and his initial theory was that the adrenals were actually sluggish and it was a mild sense of Addison's, but we now understand it's more of an adaptation, right? So we know that it's the way that our adrenal glands in our brain communicate when we've been subject to chronic stress for long, long periods of time. And that initial high cortisol response is what we typically will hear about on the news, like, Cortisol, you have cortisol that's too high. That's bad, right? You have, you know, bad cortisol, bad cortisol, cortisol is too high. But we do need cortisol to actually live, right? So cortisol helps manage our immunity. It helps to manage our, you know, our immune function, our inflammation in the body. It gives us energy in the morning. And we actually do want to secrete cortisol throughout the day, right?

Right.

What most of the people I've seen with Hashimoto's, with chronic fatigue syndrome, with autoimmunity, they actually don't have enough cortisol on board. And they have these flat-lined adrenal curves. And part of why this occurs is, you know, our bodies are adapted to respond to stress. And in ancient times, it was something like a bear chasing us, or a lion, or a tiger, right? And then we'd produce high cortisol, and then we'd get out of the threat. shakes it off, we'd go back to, you know, maybe sleep it off, shake it off, whatever, we go back to having this healthy stress response. But when we're constantly getting stress signals from our environment, our body shifts into this survival mode. And in order to, like, conserve resources and energy, eventually we're not going to be producing lots of cortisol. Cortisol is very, when we're in that high cortisol state, that can be a very catabolic process on the body, and that can be very stressful on the body. And so I kind of feel like it's a bit of the boy who cried wolf syndrome, where the body's like, okay, you're stressed. Okay, I get it. You're still stressed. You're still stressed. You're still stressed. We're just going to keep cortisol low, so we're going to save it for, like, when that bear actually comes, right? So that I can give you a burst of cortisol. And usually this is this is in the evening time for many people so that they will say, I'm so tired all day long. And then I get this burst of cortisol at night, and they don't know that it's cortisol at night. They just think that maybe they're night owls or they just have trouble falling asleep. They'll wake up throughout the night. They have unrefreshed sleep because their body essentially gets out of alignment with our circadian rhythm. So their exhausted during the day and they're wired and tired at night.

And yeah, that's the, I mean, you're, yeah, if you know, you go to bed and you're like exhausted and you're like laying there and you can't fall.

Asleep and you feel wired. That's what she's talking about. It's a very real phenomenon and I feel like it's not a disease per se, but it is exactly what happens when your body's been under chronic stress for a long time. And there's also a very predictable way of getting out of it. I know, People will say they have brain fog, they have trouble waking up in the morning, they have salt cravings, they might have coffee, caffeine dependencies. They're crawling to their coffee maker in the morning. That's probably a sign that you might have some sort of adrenal dysfunction. 3:00 p.m. crash, feeling hangry, feeling irritable, anxious, like everybody around you is just, really draining your energy, light sensitivity, addiction to or dependency on alcohol in the evenings to help you wind down. These are some of the-- Sugar. And sugar, absolutely, to give you energy. These are some of the kind of patterns that we see with people in this state. And again, it's not a disease, but it is a very predictable way the body adapts when we're under a lot of stress. Yeah, and often I see, you know.

There'S a lot of people get low blood pressure, so they basically stand up and they get dizzy or they get palpitations. or they feel like they crave salt like you said. So, these are really common things where you can see crash in the morning, can't get out of bed in the morning, crash in the afternoon, I mean, can't get out of the boarding, tired and wired at night when you go to bed. These are really common symptoms and I've certainly had them. I think you've had them. And, I bet you have people listening and going, yeah, I kind of recognize that. And, it doesn't mean that there's something fundamentally wrong with you. It means our bodies are not adapted to chronic stresses. There's a great book by Robert Sapolsky who's amazing. I hope you have him on the podcast sometimes. But he's a professor at Stanford who studied baboon stress responses. Anyway, he wrote a book called why Zebras Don't Get Ulcers, which is because they basically get chased by a lion, they go full out total stress response, the lion kills one of the zebras, and then they all go back to eating grass and they just chill. And we just keep going, we just don't stop running. The adrenal system has an adaptive response. It doesn't just fail all at once or doesn't just get dysfunctional at once. What are the stages that people go through? And how do people recognize that so they can actually avert the final thing, which I had, which was chronic fatigue?

Usually people start off with that heightened stress response where they'll release a lot of cortisol throughout the day. and typically I think of like, you know, rock stars in a hotel room, like you just have all this energy and you feel like you just drank a whole bunch of Red Bull and you can't sleep, you're wired, you're like on the go, you're doing tons of things, everybody around you is too slow, not smart enough, like they just don't get it. And so this is how people usually feel in the high cortisol state, very like irritable and they're kind of jumpy, right? If time goes on long enough, then they'll get on what I call the cortisol roller coaster, where they might start off with high cortisol in the morning, so they kind of jump out of bed and they're ready to go, but then they'll have a dip in cortisol levels maybe in the afternoon. Sometimes that's irritability, sometimes that feels like anxiety, sometimes that feels like getting really hungry, or maybe they need to take a nap at 3:00 p.m. And then as the day goes on, they'll have another spike of cortisol where they can't sleep at night. They get to bed and they're like, oh, I have a million things to do, like I need to do them. As this goes on long enough, then they'll go into more of the reversed cortisol curve, where their total output of cortisol throughout the day will be lower, and most of the cortisol will be low early in the morning. So they'll have trouble waking up in the morning. They'll be like a person that was an early bird and an early riser will say, Holy cow, I just woke up at 9:30. I used to wake up at 6:00 AM and go running. What is going on with me? And then throughout the day, they'll feel tired, but finally in the evening, they will get that surge of energy where they'll be like, oh, well, I finally feel alive now and it's time to sleep, right? Then they'll have a hard time falling asleep. And then if this progresses long enough is where most of my clients that I've worked with end up. with the chronic fatigue, with the Hashimoto's, with the autoimmune conditions, is they'll have flatlined adrenals. So these are people that are waking up tired and they're going to bed tired and they're sleeping like I was, you know, 11, 12 hours a night in some cases and feeling unrefreshed. And they're like, well, people tell me to exercise, but I feel worse when I exercise. People tell me to fast, but if I fast, I feel awful. if I get more sleep, I'll try to sleep for 12 hours and I'm still tired. I sleep less and I'm still tired. And they are just, they're really stuck in that state where their body, just every little stressor can be so overwhelming. Even things, positive stressors can be too much for them.

Yeah, I think that's true. I think the sense of being exhausted in the morning is really a big deal. It's a rush for the coffee, a sign of just being constantly irritated. It's like think about if you haven't slept for a while and you become more cranky and irritable, it's not because you're a jerk, it's just because your nervous system is just fried. And so we see this and the question is, symptomatically we can diagnose it. But are there tests that we can do to actually help figure out what's really going on?

I love recommending tests. I do a lot of them myself, and if I had my way, I would have everybody do various functional medicine tests. The adrenal saliva test can be incredibly helpful for figuring out what your cortisol pattern looks like. Then there's also the Dutch Profile, which goes a little bit deeper. It's a urine test, and it can It could look at how your body metabolizes the various stress hormones and how much it's putting out. The tricky part is I've been recommending this for 10 years now. And then people will say, I went to my doctor and I asked my doctor to test my adrenals. They said, I don't have Addison's. And I'm like, okay, well, you've got to go to a doctor that has integrative mind that is an integrative practitioner. And they're like, oh, well, I found one, but they're very expensive. And these tests I have to pay out of pocket for. so that's kind of another barrier to getting the help. And then they get the tests, they get them home, and then they're like, but it's been sitting on my shelf for three months, right? And then finally they do the test and they get the results, you know, a few weeks later, sometimes a couple of months. And it's like six months have gone by where, you know, I could have told you based on your symptoms that you are, you know, if you're chronically fatigued, there's a good chance that you're in that stress response. If you are, if you're in that fight or flight mode and you're feeling really irritable all throughout the day and you can't sleep, I'm pretty sure you have too much cortisol. So I do love tests and I recommend them, but I wanted to create a program and a protocol that was entirely based on symptoms and how to reverse and address the symptoms so people could work with their doctors and get the tests that they need, or they can really be empowered to take charge of their own health. I don't know if you've had the same experience, too.

Yes, I think it's so true because I think the, you know, most of the time people walk in and they tell me their symptoms, I can tell them what's going on, and then the test will confirm it. and I think we do see stages of the test where we'll see, for example, high cortisol at night and low in the morning or high cortisol all day initially, then it kind of drops in the morning and then it ends up being low all the time, kind of flat lining. And I think that's something that is sort of an end stage process. And in terms of the sort of treatments and the diagnosis of it.

You.

Know, you sort of, you challenge some of the traditional view of this. You say this is sort of, you know, doctors talk about this as a bogus diagnosis and dismiss it. And, you know, why do you think that is?

I think, you know, unfortunately, I think it has to do a lot with the nomenclature where the term adrenal fatigue, it was initially coined where the person that, and the the brilliant people that coined the term and started educating the world about it, the initial understanding of the mechanism of action behind of what was going on was kind of like a mild Addison's or that the adrenals were not capable of producing cortisol, where we know it's more of an adaptive system where the adrenals are capable of producing cortisol, they're just not releasing the cortisol at the right times throughout the day. So that's what ends up, I think, kind of boggling a lot of people. And some practitioners argue about the terminology. So they'll say adrenal fatigue doesn't exist, but then you'll look at HPA axis dysfunction or hypothalamic pituitary adrenal axis dysfunction. And that is a real thing. And there's published literature around it. And same with like leaky gut 10 years ago, it was like, it doesn't exist. And then it's like you go to PubMed and there's like, Intestinal permeability. So basically, you just have to use the right terminology, I think, for them to get it. But you can call it burnout, you can call it adrenal fatigue. I call it adrenal dysfunction because I feel like it rolls off the tongue a little bit easier than hypothalamic pituitary adrenal axis dysfunction. And it's a little bit more of an updated term to reflect the mechanism of what's going on as far as we understand it these days.

Yeah, amazing. So, in your book, Adrenal Transformation Protocol, you talk about, you know, just chronic stress being a huge cause of this and how it creates a demand for high cortisol and adrenaline. Hi, it's Dr. Mark.

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And now let's get back to this week's episode of the Doctor's Pharmacy. But you talk about four different kinds of stress. I think this is important because it's not just psychological stress that can cause adrenal burnout, as it was for me, it was something else. I mean, it was physical stresses and some psychological stresses, but it was a combination of things. So I wondered for the audience, would you just send them unpack the four.

Types of chronic stress that can sabotage our adrenals. So it could be psychological stress. So you're going through graduate school and you are waking up three times throughout the week at 5:00 a.m. to go to do your exams. That can be incredibly stressful. You have a really annoying boss who's just a jerk. That could be incredibly stressful. You have a lot of family drama that's currently stressful. And people recognize these kind of stressors. I know one of my books, somebody wrote a review that was like, I didn't need to do anything that she recommended. I just quit my job and my whole life got better. I didn't have autoimmunity anymore. and I was like, amazing. Like, if you could recognize there's this, like, one thing in your life that's causing you stress and get rid of it, that can be a big game changer. But there's also, like, positive stressors. So you have a beautiful baby, and that beautiful baby doesn't sleep. Right? So I know that was a stressor for me five years ago when I got into adrenal dysfunction another time in my life. You got married and you moved across the country, or you got a job promotion. These are positive things in your life, but. but they can be a bit overwhelming. Then there are kind of like hidden psychological stressors. So maybe you had a history of adverse childhood events, something you happened in your childhood that was traumatic. You probably don't even have a recollection of it, or maybe you do, but it has shifted your HPA axis to be more on high alert and kind of put you in that survival mode. And you've got that on your plate. So that could be something that people aren't necessarily aware of because it's not present day stress. Their present life might be perfectly peaceful. Then we think about, like, the physiological stressors. So I'm always like, what is in your life right now that could be causing your ancient genes to think that you're under stress? Let's, like, unpack modern life. If you are not sleeping a lot, if you are skipping meals, if you are exercising over exercising, right, if you're eating foods that are to you, your caveman or cavewoman brain is going to say, holy cow, we must be in a war, in a famine, or being chased by a herd of bears or something. Because why on earth would you be eating stuff that's inflammatory? Why would you be starving yourself? You must be in a famine. So let me help you out from an evolutionary perspective, and let me shift you into this adrenal fatigue state so that we can conserve your energy, we can conserve your metabolism. So these are some of the modern day stressors and sleep deprivation is probably the fastest way to get into this adrenal dysfunction.

Yeah, you know what's interesting is that, you know, people don't realize that actually their diet can be a stress that actually sugar and starch when you eat it causes a flood of adrenaline and cortisol into your system, even if it's oatmeal. David literally showed this. It was really shocking years ago in a study of obese kids where he gave them oatmeal or eggs for breakfast. And the kids who ate the oatmeal had high levels of cortisol and adrenaline because of the glycemic load of the oatmeal, which we think is a healthy breakfast. And cereal is even worse. And that drives, you know, higher levels of stress hormones and that it makes you hungrier, it makes you crave sugar, it causes high blood pressure, just all kinds of issues. So I think it's important to highlight that.

Oh my gosh, absolutely. One of the key stressors is blood sugar imbalances. So just eating too many carbs and too much sugar and then not enough protein and fat, this is a really, really big stressor for many people and being micronutrient deficient. That's actually one of the key transformations as we focus on blood sugar balance and people will say, I thought I had anxiety. Turns out my blood sugar just needed to get balanced. And I thought I had insomnia. I was waking up at 3:00 a.m. and I wasn't sleeping through the night. It turns out that it was actually my blood sugar. So this is such a really, really important stressor. And I thank you for bringing that up because this is a core part of transforming your adrenals and transforming your stress response is like the nutritional signals, right? figuring out how to get yourself in balance. And then there's also like the hidden stressors where people might not realize them. They're not in their lifestyle. Their lifestyle might be like spot on and perfect, right? But they might have an H. Pylori infection or they might have a toxic exposure, perhaps mold exposure or some other kind of toxin that could just be sending their system haywire and sending them into that survival mode even though they're like, I'm doing everything right. I'm doing all the things. I'm sleeping well. I'm like, I have a good marriage and I love my job. And all of a sudden, I just feel terrible. And usually in that case, it could be a hidden source of inflammation in your body.

Totally. And I think that what's interesting is when I had chronic fatigue, it was because I had mercury poisoning and that screwed up my adrenals. So, it was some external thing or Lyme disease or mold or whatever it is. anything that drives inflammation, as you said, can cause adrenal dysfunction independent of what your stress levels are psychologically. So that's really, really important. And also rhythm, we talked about, you know, sleep, but having regular wake and sleep cycles is important. Eating at their same times is important. Your body is a biological clock and there's a whole system of medicine called chronobiology, which is the science of even how to, for example, treat cancer with certain chemo drugs given at certain times of day. And I think we kind of lose track of that and we just think we can go kind of buffet about our body with all sorts of irregular schedules. And that is really not good for us. And it really requires sort of a discipline of a repeated state of circadian rhythm and of reducing the things that cause adrenal dysfunction. to kind of help you, help you fix that. You know, one of the, one of the things that people don't realize is that the gut plays a big role in your adrenal function. Can you kind of unpack that for us?

Oh, yeah, absolutely. So whenever, and it's kind of a two-way street, right? So whenever we have infections in the gut, and I typically see, you know, we talked about all these different stressors. Some people just have one stressor. For most people, it's like stress bucket that, that, like, overflows when we either have, like, one major big stressor and a whole bunch of little ones or even just a whole bunch of little ones or, or, you know, moderate sized ones. Whatever. Whatever happens is, like, your, your stress signals are like, you have way too much stress in your life. You have too many danger signals, and you shift into that survival mode, and part of that could be coming from your gut. So a lot of times I'll see people that I've worked with in that chronic fatigue state. And interestingly, there's research talking about CFS and some of these things, but people will typically have some sort of gut infection. So they might have an H. Pylori infection, they might have a protozoal infection in their gut, they might have Candida overgrowth, they might have dysbiosis, they might have mold colonization. And all of that shifts the body to have more inflammation. and then the other piece of that is when we're under a lot of stress, our secretory IGA levels are depleted. Our secretory IGA is what keeps our immune function in the gut and the respiratory tract. So people end up being more susceptible to all kinds of illnesses and whatever pathogens are in their gut, they're more likely to kind of take over the gut and like, you know, set up residence when you don't have a good enough secretory IGA response. And you might be the person that you go to a restaurant with your friends and you are all eating the same things, but if your secretory IGA is low, everybody will be fine, but you'll get food poisoning because you'll be, your body won't be strong enough to overcome whatever microbes are, are, you know, naturally present in the food. And so it's a really, really big two-way street. So part of my plan with the adrenal transformation protocol is utilizing, minimizing inflammatory foods that can cause inflammation in the gut. And then we also focus on utilizing a beneficial yeast called Saccharomyces boulardii to raise that secretory IgA response. And this can make you more resilient to stress. It can help you overcome food sensitivities. It can clear out some of the pathogens. from your gut, like the Candida, like some of the protozoa, like some of the H. Pylori and so on and so forth. Just kind of make your gut a little bit more healthy and a little less inflamed.

Amazing. So yeah, everything is connected. This is Functional Medicine 101. Everything is connected to everything. So I think we have to realize that, you know, I always say our body has only so many ways of saying, oh, so many different insults can disrupt adrenal function and obviously thyroid function, which you've written about. Why do you think it is so prevalent? I think everybody listening is going, God, I recognize those symptoms. I've experienced this. I get it. And it's it's like it's just this invisible problem that most people don't get the right therapy for. Why do you think that before we get into what to do about it, so many people and women in particular have thyroid adrenal and autoimmune stuff going on?

Yeah. Like, it's so common that people almost think that it's normal. But I'm like, just because it's common doesn't mean it's normal. And I think really it is a consequence of our modern life because we are disconnected from the circadian rhythm.

Right.

So we are not sleeping well enough. So we're not getting that rest and digest period. We are constantly have a culture to keep working harder. to side hustle and do all the things. And then we end up really hearing about how we need to lose weight. And so we restrict calories. And I feel like all of these, I guess, signs with modern signs that get interpreted by our ancient genes, our genes don't know what to do with like, hey, we're always under stress. They're not adapted to that. Cavewoman, caveman life was pretty chill. You would eat your food and then you'd relax. You'd go hunting and gathering. Every now and then you'd have a situation, but you weren't doing a side hustle. You didn't have three different jobs to make ends meet. And certainly there's a lot of things going on in our modern times, especially in the last few years, that I feel like have made us feel like we're not safe in our modern world, right? So we have just the fear in the last few years about like, you know, we don't know what's happening in the world. There's war, there's a pandemic, there are people that are, you know, also worried about their children throughout the pandemic. You're worried about your relatives and elderly relatives throughout the pandemic, or maybe you're immune compromised. And so I feel like a lot, the last, I've seen it a lot of it just in the last 10 years, but especially in the last few years, I feel like, you know, my girlfriends are like, Hey, I don't have Hashimoto's, but I have all these symptoms. I have the brain fog, I have the fatigue, I have the anxiety, I have all the things. And it's because the body shifts into that stress response and that survival mode when we get the message from our environment that we're not safe. And our body's always just trying to help us to adapt and protect ours, our survival. Right. And so it is very, very common and more common in women because women have more receptors to be tuned into the environment. We do bring new life into this world. And so it's really important to know if it's a safe time to bring new life into the world or not. And so we're wired with more estrogen and more hormones that are going to be receptive to stress, right?

It's so true. It's so true. So let's talk about the solution. Because I think everybody's going, okay, okay, get it. I've had this problem or I have some level of it. mild or it could be very severe. What is your adrenal transformation protocol? It's quite different than most sort of integrative doctors who say just, you know, get checked, test your adrenals, quit caffeine, sleep a little more, maybe try DHEA. You know, what's different about your approach to restoring adrenal function? Because, just to be frankly honest, in terms of functional medicine, it's one of the hardest things to do. And it takes a long time for me to help people to completely reset. It's like a complete revamp of their lifestyle. They have to get off all the inflammatory foods, sugar and processed food. They have to develop a regular rhythm of waking and sleeping. They have to expose to sunlight in the morning. They have to make sure they don't over exercise. They need to practice meditation, yoga, get acupuncture, take a bunch of herbs. It's like a lot. And it takes, it's not like, oh boy, they get better. So, It's very slow. So can you talk about how different your protocol is, what is it, and help us understand how to restore our adrenal function?

Asking for a friend.

So all of the things that you said can work incredibly well, but like you said, they do take time and they're not the right fit for everybody. So 10 years ago, 10 plus years ago when I recovered my health, I utilized pregnenolone and DHEA, and then I would recommend that to my clients and sometimes hydrocortisone, all the sleep, 10 to 12 hours of sleep a night and letting go of a lot of stressors. And that worked really well for a lot of people, but then it didn't work for some people. And I was just like, ah, you know, maybe they're just resistant to change and so on and so forth. And then I became a mom five years ago, and I was like, I'm so sleep deprived. My beautiful baby is eight months old. I thought they were supposed to sleep at three months old. Hold on. What's going on here? I was lied to. And so when he was eight months old, I was waking up every two to three hours to feed him at nighttime and was just like, holy cow, I think I crashed my adrenals. And I did a test for myself, and sure enough, they were flatlined. But I'm like, I can't take DHEA. I'm a nursing mom. I can't sleep for 12 hours a night. I'm a nursing mom. I wish I could sleep. And then I was like, well, and I can't quit coffee. Like, I just started drinking coffee. Like, it helps me so much. Like, you can't take it out of my hands. And I remember having clients, I would tell them, you know, you're waking up at night and you're so tired throughout the day and you're drinking six cups of coffee. Like, I think you should just quit the coffee and you'll be fine. And they'd be like, well, I quit the coffee and I still feel like crap, right? I'm still waking up all night and I'm still tired throughout the day. So I was like, oh, wow. I guess, you know, I really have to like, I don't know, like, I have to get out of this. I have to feel good again. What do I do? And I kind of went deeper into my safety theory where I figured out, you know, what are the stress signals my body's receiving, right? And then how do I counteract that with some safety signals so that I can shift my body out of that survival state into more of a thriving state? And the beautiful thing is when I was going through the functional medicine process and all of the integrative wonderful tools that would take three months to two years to see results. With this, it took like three to four weeks. And I was like, holy cow, this is working. And then I piloted it with over initially with about 200 people, 92% saw less brain fog, more than 80% had less fatigue, and so on and so forth within just that three to four week time period. so that's that's why I'm like writing a book on it because I feel like it's a great approach that is complementary to the testing and to all of the wonderful precision of utilizing hormones, if that's a route that person wants to go. But I really focus on supporting the body and its stress response. So you'll see the things that are foundational from functional medicine and from integrative medicine like the adaptogens, those can be utilized. The B vitamins, vitamin C, magnesium, and electrolytes, that's kind of the part of the protocol. But I'll also utilize mitochondrial support, so specifically D-ribose, rhodiola, and carnitine. And that can really transform a person's brain fog, anxiety, and their ability to sleep really quickly. as well as myoinositol to help resolve some of the anxiety, some of the blood sugar swings, and help them sleep better. In addition to blood sugar balancing, aligning with the circadian rhythm, and then a lot of the transformational techniques of building energy, some of them are really focused on creating pleasurable activities throughout your day, and that can be just a really big game changer for people who don't do things they enjoy throughout the day, right? So connecting in nature, having time with friends, things of that nature. We go through a whole process where I have about 14 different safety signals. So to kind of outweigh the stress signals that we're getting and we're also turning off some of the stress signals throughout the process.

So it's a whole combination of things including dietary changes, bringing pleasure in your life, getting your circadian rhythm set. And what's different about your approach is some of these unique supplements. Is that what makes it sort of different? Is the rhodiola, the myo-inositol, the carnitine?

So a big focus of it is on the mitochondrial support. So you might have noticed adrenal transformation protocol. It's ATP. So that is part of it. Yes, yes. So ATP is- I didn't even catch that. It is our energy, you know, energy throughout the body, how our mitochondria creates energy throughout the body. And so that is a big part of it, but also a lot of transformational work too. So looking at how to create joy in your life, a lot of times I feel like people are fatigued not because they're doing too many things, but because they're not doing the things that bring them joy and energy. and that really bring the spark into their lives. So they're drained by doing mundane tasks and kind of shifting your daily routine to adding some pleasure into your life can actually sometimes be more effective than like utilizing supplements and nutrition. I mean, and I combine it all, and this is why I think people have such fabulous results. And I don't ask them to quit caffeine, right? oh, this is. Yeah, yeah.

You still love coffee in the morning?

Yeah. If you could.

Not 12 cups a day.

Not, gosh, no. Not 12 cups of coffee in the morning, but we focus on really building up their energy levels. And so usually by week two or three, they're able to wean off the caffeine naturally and they don't need it. So if you get enough bright lights in your morning, you step outside, you get some bright lights into your morning, you do the adrenal Kickstart drink that I recommend, which is. a little bit of orange juice and sea salt and protein and fat. You do that in the morning, and then you're gonna be like, holy cow, I don't even need my caffeine because that's gonna raise your cortisol level naturally. And then people sleep really well at night throughout the program, so then they just naturally wean off. Like, some people are like, you know, I want to be on coffee. I love coffee, or I love my Earl Grey tea. and that's fine. If you're having an unhealthy relationship with your caffeine, with your sugar, with your wine, then we're gonna give you the energy. You need to break up.

If you have a bad relationship, you have to break up.

You have to break up with that, absolutely. But we wanna get you to a really healthy relationship with the caffeine. So part of that is making sure you have enough energy so you can actually quit the caffeine. If you don't have enough energy, if you're sleep deprived, you're just gonna kind of go back to your habits. So a big part of the process. And we do see shifts in about the first two weeks where I've done the program seven times now with groups of people over 3,500. And initially they're like, I'm so overwhelmed, I'm so tired, I'm so stressed. And by week two or three, they're like, I'm running up and down my stairs. I clean my whole house, like my libido's back. I feel so amazing. And it really focuses on you know, like supporting your body's energy pathways and also like letting go of the things that really weigh us down. So a lot of the transformational work focuses on are we having stories in our heads that maybe are weighing us down and how do we transform that and how do we create a trigger toolkit so that we are not drained on a daily basis by things that trigger us.

That's interesting you talked about this. identifying what is triggering us. Because one of the things that drives chronic stress response and chronic disease is what we call adverse childhood events. They have the things and bad things that happen to some of our kids, whether it's neglect, whether it's her parents yelling at us, whether it's abuse or physical or sexual abuse. I mean, any degree of that, depending on the person and their sensitivity and their actually even their genetics, because genetically we actually are designed to respond differently the stress. Some people are much more resilient, others aren't. And so when we get these events in our childhood, they set us up for feeling like the world's not a safe place. They can lead to PTSD, autoimmune diseases, all kinds of things, cancer, heart disease, early death. They affect this fundamental regulatory system that we're kind of hinting around called the HPA axis, which is the hypothalamic pituitary adrenal axis that is so essential to regulate all of our biological functions. It's our hormonal orchestra, and basically our conductor of our orchestra. And that becomes adversely affected. And so you talk about how do we sort of change our response to the triggers that activate these ancient, or not ancient, maybe like from our childhood, sort of software programming that's sort of corrupted. and creates a disproportionate response to an event now that may have been big when we were a child, but is now really not like that. So how do we begin to sort of deal with those things in a practical way? You did sort of hint at it, but I'd love you to go deeper on that.

Sure. So part of the plan is creating yourself a trigger toolkit and so figuring out what are some of the things that trigger you and what can you do when you are triggered, right? So let's say somebody says something to you that makes you really angry and drains your energy. How do you come back from that? Do you yell at the person? Probably not a good idea. But are there positive ways or ways that you can de-stress from that? So maybe somebody really triggers you and says something that makes you crazy. One of the things to do in the moment, and I encourage people to make a list of things, we have a list of things to consider, but you might find that going for a hike might help you feel better, right? That might be a way for you to dispel that anger or angry energy by going for a little bit of a hike if you enjoy time in nature, or maybe taking an Epsom salt bath to kind of support your body in that way. You might find that giving yourself a hug or talking to a friend might be a very, very great way to to deal with those triggers. And then also making a plan for if you know that there are things that trigger you, your triggers are like your healing plan. It's like this is where the sun comes in. If you notice that you get triggered when people say certain things to you or certain things happen, that's actually a really good thing to be aware of that because you can work on these things and and take that trigger response off. One of my favorite approaches to this is called EMDR therapy. This is eye movement desensitization and reprocessing. It was developed by Francine Shapiro, a psychologist who found that when our eyes moved from left to right, this kind of tapped into a part of our brain. And you can use this in a therapeutic process where you can essentially reprocess old traumas, and you experience them with, let's say they were childhood traumas and they led you to believe certain things, you know, 40, 20, 30, 45 years later, something that happened that when you're five still has so much control over you. You can actually reprocess them and relook at them as adults. And you can, you know, let's say you were neglected as a five-year-old, you can go back in time, essentially, and make these different neural connections where you can be that parent for that five-year-old and show up for yourself. So it's just an amazing therapeutic process that can work in one to two sessions to overcome most traumas. And then you'll find the things just don't trigger you like they used to. I was, to give an example, I was in a traumatic car accident when I was in my first year in college. I was driving with a girlfriend coming home from school and then one of my tires popped. We were driving like 90 miles an hour on like a three, you know, like a huge six lane highway in southern Illinois. And my car's tire popped and I swerved into oncoming traffic. So there were tons of cars coming at me and I ended up in a ditch with Whiplash and I had a bit of PTSD after that. I couldn't drive a car for a while. and I would get in a car and I would start crying because it was so scary for me to drive a car. And I had one EMDR session on that. And after that point, I was like, okay, I can drive a car again. Like, I'm not stressed out by, by that. And so they can be a really amazing therapy that I've recommended for a lot of my clients. And they'll find, you know, and, like, talk therapy can be great, too, but doing something like this that actually helps you. reprocess the trauma so you can kind of shake it off and go on with your life and not let it like eat up at you can be incredibly healing and make you more resilient and strong.

Powerful. Yeah. And it's really how to sort of reset our relation to stress in our life. And I think most of us are chasing things that, that, you know, keep us stressed, whether it's money or success or just trying to get by. And I think, like you said, bringing joy back into life is so key because at the end of the day, what matters, you know, I remember that. I don't know, it's a poem written by some woman, if I kind of was dying and if I had to live my life over again, I would spend more time smelling the flowers, talking with friends, laughing, taking hikes, doing the things that bring joy and that are really the juicy part of life rather than work, work, work, which is our crazy culture. I want to dive a little bit more deep into this whole idea of adaptogens. You were talking about this in your program. There's a whole set of herbs and compounds that are available from nature. that seem to help reset our nervous system, that help us adapt to stress. For example, the cosmonauts were on, for example, lots of these adaptogens when they went to outer space to help them be stress resilient in outer space. Can you talk about some of the highlights in this family of adrenal adaptogens that are available to us from herbs to mushrooms to all kinds of stuff?

Yes, there are so many different adaptogens out there and I typically would recommend for most people to take them if they're in a stress response unless they're pregnant. They're even safe for nursing moms, but usually nursing moms just need to take maybe one or two in smaller amounts and check with their lactation consultant. But all of them have different personalities where some of them may be more beneficial for for one aspect versus another. And the beautiful thing about adaptogens is whether you have too much stress and too much cortisol or not enough cortisol, they provide a balancing effect in the body, right? So if you have too much cortisol, they'll normalize that thermogenesis.

Like a thermogenic kind of, you know, keeps your soup hot and your lemonade cold.

Exactly. They have that beautiful effect, so you don't necessarily need to worry about if you have too much cortisol or not enough cortisol, you can utilize them and they'll help you adapt more to stress. Now, I always tell people, when you take adaptogens, you become more resilient, so the stress kind of bounces off of you. And how it typically manifests for a lot of people is people in their life just become less annoying, right? Like magically everybody just is less annoying to them. And because they have a little bit more resilience, a little bit more patience, a little bit more Joy, less anxiety, less of that fatigue. They're sleeping better at night. And I have, you know, I have a list of them throughout. Some of them are very helpful for depression, anxiety, such as rhodiola. Ashwagandha can be fabulous for people with thyroid issues because it can help with supporting healthy TSH levels. then we have things like maca and shatavari that can be helpful for people with libido issues. They can sort of have some of those wonderful properties. And other ones might be helpful for helping you sleep. I really love reishi. This is something that can give you some energy in the evenings to kind of feel really good and healthy and also help you sleep really well at night. And this from a mushroom.

Yeah, I think that's really important. So maybe kind of let's dig into the sleep thing because I think this is one of the challenges that people who are so exhausted is they can't sleep and their biology is not giving them a chance to rest. And you want to sleep, you're exhausted, you go to sleep tired, but you can't fall asleep, you wake up tired. How do we reset sleep? You mentioned a few things here and there, but sort of go through the protocol for fixing sleep.

Okay, great. So, I'll share something that works for about 50% of the people. The results in the program have about 80% success within sleep within three to four weeks. And I'll go through the whole process. The 50% of what works for 50% of the people is making sure you get morning sunshine throughout your day. You're eating every two to three hours, protein and fat, if you're somebody that likes to eat.

Every two to three hours, really.

Well, initially, initially for people that are really in that low cortisol state, you're going to be eating on a schedule. So you're going to be, you know, you're going to have breakfast and then you're going to have lunch. You might have a 3:00 p.m. snack if you get that blood sugar hangry crash and then having dinner around 6:00. So we're kind of, a lot of the people that come to me, they're not eating breakfast, they're not hungry throughout the day, and they tend to wake up at 3:00 a.m. and having to eat a snack. So we're kind of shifting your eating to daytime so that you're kind of getting more calories throughout your day and through daylight hours to let your body know when it's time to like be wakey wakey and when it's time to sleep. So part of that is like that circadian eating. And initially for a lot of people that looks like we're eating every few hours because I have a lot of people that skip meals. and we're trying to reestablish that, Hey, it's daytime. We're eating now. And we're trying to eat outside whenever we can. We're getting that bright light throughout the day. And we're really trying to get protein and fat into a person's system, specifically protein, because that a lot of times if we don't get enough protein, we're going to be waking up throughout the night with blood sugar swings. So this is part of the plan. Then we make sure we're not exposed to bright lights in the evenings. as much as possible. So you can wear, after sunset you could do something like blue blockers and put your phone on a nighttime setting. If you're watching a show, taking out all the blue lights in your house, in your bedroom so that you're not waking yourself up. That can tell your body to wake up in the middle of the night. And then utilizing something like an Epsom salt bath as part of your evening routine. so you can kind of get warmed up and that lets your body know to relax. The magnesium from the Epsom salts helps you to get more into relaxing, reduces your anxiety, your pain, kind of all of the it has sleep promoting effects you get out of the bath, that little cold exposure also helps you sleep. You sleep in a cold dark room. And this is kind of like the lifestyle foundationals that can work wonders for a lot of people. Now, I get into a little bit deeper into, okay, if you have trouble falling asleep, what are the things to consider there? So having a good nighttime routine can help doing something like GABA for some people might help to get rid of that racy mind. Then we go into, if you're waking up in the middle of the night, that could be a blood sugar issue. So I utilize myo-inositol and carnitine in the evenings. to help with blood sugar swings, and that usually helps. If you're waking up frequently throughout the night, that could be an ammonia issue. So people with too much ammonia in their system, there's a lot of interesting research with frequent night wakings and brain fog connecting to ammonia, and part of the way we can produce excess ammonia is we're not digesting proteins, CBS gene mutation, H pylori, various inflammatory pathogens in the gut having constipation. And so I'll utilize like magnesium to support the clearance of ammonia. Carnitine also supports the clearance of ammonia as does sarcomiasis bulardi. And that's like the people with frequent night wakings. I had a few clients with that, so I had to like really dive deep into that.

Really? and how do you get rid of the ammonia?

Well, so some of the ways to clear magnesium citrate, if you're having frequent, if you're constipated, that can be very helpful. You can utilize sarcosine bolardi to suppress the production, to suppress the pathogens that may produce ammonia in your gut. Carnitine helps to clear out ammonia from, from the gut as well. And then for people, and I have, the book is organized by like a, four-week protocol. So this is very simple. This is what you do. Here's the diet, here's the six supplements, here's the lifestyle changes. And then at the end of the book, it's like, if we need to tweak it for those 20% of people that are still having trouble with sleep, you can try these other things. And then ornithine is something that can be really effective for clearing ammonia out of the body. So there's a lot of research with you.

That's amazing. And all this is in your book, right? All this is in your adrenal transformation protocol.

It is. It is. The last section, I had to work so much on trying to get the word count of the book to include all of this. I know. I know. Yeah, it's always tricky to try to get it all in, but it's a really solid protocol that you can follow for four weeks that 80 to 92% of people see really amazing results. And then I have a section on how to tweak things like if you're still struggling with sleep issues, here's like additional things to consider for your specific situation.

Well, this is such a great gift to everybody, Isabella. I think this is such a rampant problem in our society. I think that it's underdiagnosed, it's under understood or misunderstood by most physicians. And I'm really grateful that you've synthesized all the research and put it in a usable practical guide for people to reset their nervous systems. Because I think so much of what's wrong with us today in this society is just this chronic stress response that's causing so much either. So stress causes or makes worse 95 of all illnesses. So it's a powerful, powerful thing. And I think your book, the Adrenal Transformation Protocol, it's available now. Everybody needs to go get a copy. You've got a wonderful guide online called the ABCs of Adrenal. support, which is free. Check that out and to learn more about your work. Where else can they go to learn more about what you're doing?

Sure. Thank you so much for having me, Dr. Hyman. I have a website called thyroidpharmacist.com where people could learn more about the work that I'm doing. I share helpful articles every week. And then I'm also on Facebook as thyroid pharmacist Dr. Isabella Wentz and then on Instagram. as Isabella Wentz PharmD. So helping to connect with everybody. Amazing.

Well, so, so great to have you on the podcast, Dr. Pharmacy. If anybody listening has had adrenal fatigue and understands what it is, make sure you get the book. Share it with your friends and family. Share this podcast. I bet you they also struggle. And this is a doorway for them to get better. Leave a comment. How have you recovered from exhaustion and adrenal what are the practices? Maybe we'll learn something from you and subscribe wherever you get your podcast and we'll see you next week on the Doctor's Pharmacy. Hey everybody, it's Dr. Hyman.

Thanks for tuning into the Doctor's Pharmacy.

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