Is "Adrenal Fatigue" Causing My Anxiety?

Hi, I'm here to talk about adrenal fatigue and your adrenal glands and the fight flight freeze response. Have you ever wondered if your adrenal glands could be part of why you feel anxious or that wired and tired feeling? And have you ever heard that adrenal fatigue doesn't actually exist? What does that mean? And how do I understand what's actually going on in my body so I can get to the root cause of my anxiety? We're going to be talking about all of that today during our Facebook Live and we're going to be recording this. So if you don't catch it all, don't worry, there will be notes in the show notes so you can go and read more. And then of course, we'll have this recording up here for you today after we talk about adrenal health and anxiety here we're going to be going into the private Anxiety Freedom Warriors Facebook group and I'll be doing more of a Q and A and talking about stress and what to do about it. And so if you're not a member of the warriors group, then check it out. The link will be in the show notes. And so I'm excited to talk with you first and foremost about your adrenal glands and how those may or may not be playing a role in your health. You're here in my office. I'm sitting on the floor and I have a whiteboard upon which I have written a ton of notes. And I'm going to be rotating the camera so that you can see it. But also I will be taking a photograph of it so that you'll see it better when you zoom in on your camera. So don't worry if you can't see or read everything because I'll make sure that I put a picture up there and then we'll explain it in a lot of detail. So the question that people often ask is what are the adrenal glands and what are they doing in terms of my anxiety? So let's dive in there. I will show you the picture I have drawn here. So that's kind of a lot, right? So I want to start up in the top hand corner over here and we're going to talk about the adrenal glands. So your adrenal glands live on top of your kidneys in your back. And the adrenal glands have two parts. One is the inner part, which is called the medulla, and then the outer part of the adrenal is called the cortex. And the different parts of your adrenal gland release different hormones. So the medulla, that inner part, releases what are called catecholamines. Catecholamines are like adrenaline, norepinephrine, epinephrine. These are the hormones that you feel when you get that burst of energy, that kind of fight, flight, response. People describe this when they get a shot of epinephrine. Like if they're having an anaphylactic attack and they receive epinephrine and that surge of energy, the blood vessels throbbing with blood, the heart throbbing, your airways opening, your muscles are urging to run. So this epinephrine, the adrenal and the adrenaline and the noradrenaline are a really important part of that ability to fight and flight. And your medulla actually also releases dopamine and, you know, dopamine as that feel good neurotransmitter. Then we have the outside part of the adrenal gland, which is the cortex. And the cortex releases three different categories of hormones. One is mineral corticoids, the second is glucocorticoids, and the third is androgens. So the mineral corticoids, let's start there. Mineral corticoids. An example of that is aldosterone. So your adrenal glands are releasing aldosterone. And then we move over here to learn about what aldosterone is. And the reason I think it's important to dive into all of these is because your adrenal gland as a whole organ, if it's healthy, all of these are going to reflect that level of health. And if your adrenal gland is unhealthy, then we're going to be seeing evidence or tips across the whole board. So one of the things, the cortex, remember the inside of your adrenal glands, what that's going to release? One of the things is aldosterone. Aldosterone is important for maintaining your blood pressure and, and it regulates the balance between potassium and sodium in your blood. So one of the symptoms that your adrenal glands aren't releasing enough aldosterone is if you feel really dizzy or you feel like you get a head rush, if you go from lying down to standing up, or you go from sitting to standing up quite quickly, if the adrenal glands aren't releasing adequate aldosterone, then you might find that the blood pressure drops and that we feel really dizzy and you feel like we might pass out. And so that's a sign that your adrenal glands aren't sufficient or producing enough aldosterone hormone. The next thing is glucocorticoids and so we know all about cortisol from the research and how cortisol is a big part of that fight flight, freeze response. Cortisol helps us have the energy to wake up in the morning. It gives us a spike so that we can go throughout our day, and then cortisol should go down towards the evening. And so the cortisol response looks something like this. So if we start here, and this is 8am, the cortisol should spike right when you're waking, and then it should start to go down towards the evening. So let's say this is 8:00pm and so what I commonly see is that people will go to the doctor and they'll test their cortisol. But there's a couple things that are a problem with just doing one cortisol test. And one is that driving to the doctor's office and getting your blood draw is stressful inherently for many people. And, and so then we may see a false elevation in cortisol. The other thing is that your cortisol is going to change throughout the day, and so the reference range needs to reflect that. So some people, they have what we call a reverse cortisol rhythm, where it starts low and then it spikes later in the day. And so these people, they feel exhausted and lethargic throughout the day, but then they can't sleep at night and they feel agitated and they may deal with insomnia or anxiety at night. Other people, they're just flatlined throughout the entire day. I see this quite commonly in people who've been under chronic stress, chronic ptsd. There's a study done of Holocaust victims, and they found that their cortisol production was fairly flatlined. And then there are other people who are in the midst of acute stress, and then their adrenal cortisol levels are just high all throughout the day. So the best way to test your cortisol is, is to do several tests. So we would do it in the morning when it's spiking at a random time throughout the day, in the evening. And then if the person is waking up in the middle of the night, do a middle of the night test as well so that we can start to plot out where your cortisol levels are and optimally support that. So we talked about cortisol. Cortisol has a lot of different roles, and so we write about that here. And so cortisol, like I said, you're going to get a picture of this where we're quite a lot more zoomed in so you'll be able to read it better. But what we talk about. So cortisol helps with aldosterone to maintain your blood pressure so that it's high enough so that you don't pass out. But it can be the reverse, too. Cortisol can make us have high blood pressure. And so that's why sometimes people, when they're under a lot of stress, their blood pressure goes up. Cortisol also helps with slowing the inflammatory response. It increases your blood sugar and it regulates your metabolism. So when we're looking to try to identify what the root cause of your symptoms are by understanding, number one, what your cortisol levels are throughout the day, day and the evening, and then also knowing the different roles cortisol has, it can really point to quite a lot of data about what's going on in your health and your anxiety and your well being. So we talked about your adrenal medulla and how it releases three things, primarily adrenaline, noradrenaline and dopamine. Now we're talking about the outside of the adrenal gland, we're talking about the cortex. We talked about the aldosterone and how that's really important for your blood pressure. And now we talked about cortisol. And then the third thing that the cortex of your adrenals releases is DHEA and testosterone. And so these are identified as male sex hormones and they're really important. So here's where we talk about dhea. And so the dhea, the number one role, is to help our bodies make testosterone and estrogen. This is particularly interesting to me when I have somebody coming in with menopause or who are perimenopausal. So as our body starts to transition, where the ovaries go into retirement, estrogen levels go down. We have to make sure that we're finding an optimal balance in our DHEA production. Because if your testosterone is too high, then that can push down your estrogen. It can cause symptoms of agitation, anger, anxiety, frustration, insomnia. And also we also know that the DHEA will help us make estrogen. And so sometimes when people go into menopause, the adrenals, they aren't producing adequate estrogen to compensate for the ovary production of estrogen going down. And so then a solution to that is someone is having difficulty in menopause with anxiety and night sweats and emotional distress. All these different things actually supporting the adrenal glands in the production of DHEA to help them make their adequate amounts of estrogen to compensate for the ovary shutting. Down can be really helpful and life changing and is a great alternative to doing hormone replacement therapy. DHEA is anti aging. It improves your cognitive function, so it can help with concentration, contemplation, memory, quick recall. So DHEA is really important. And then it lifts depression. So sometimes depression is a result of too low dhea and too low DHEA could be due to adrenal insufficiency. And then we will talk later about what can cause adrenal insufficiency. Right. So the last thing about DHEA is bone density. And so that's also particularly important as we age to make sure that our bones are nice and strong. And in a future video, I'll talk about the two ways that I test for bone density. We have to look at the density of the bones and then also how quickly they're breaking down. And so I'll teach you more about that. Stay tuned in the future. So then we're talking about, so we talked about dhea, we talked about testosterone. And so now I want to tell you a little bit more about what adrenal insufficiency actually is. So people talk a lot about adrenal fatigue, but when we're under a lot of stress, the opposite typically happens. The adrenal glands are designed, our bodies are designed to be able to mount a stress response. And so when we talk about adrenal fatigue, what's actually happening if the adrenals are truly not producing adequate cortisol is we have to identify what's going on, going on with that. And so this is a drawing of a little bit of a pathway. I know it's quite elementary, but for purposes of this video, I think it will make a big difference. It'll help. So we have a picture of the brain, and in the brain we have something called your hypothalamus. So the hypothalamus is in the midbrain. And what that does is it releases corticotropin releasing hormone. And that hormone goes into your pituitary gland. So I have a beautiful pituitary gland drawn over here. And then your pituitary gland releases something called adrenocorticotropin hormone. So that goes down to your adrenal glands. Your adrenals release their hormones, which we talked about over here. And then those hormones go through the body and they create a cascade of responses. What happens then in response to that is if your adrenals are making all the hormones they need to make and things are going well, we'll get a negative feedback loop that tells the Brain, okay, you did your job. The adrenals are doing theirs. You don't need to tell the adrenal to do its job anymore. It's got it. So it creates a negative feedback loop so that we don't make too much acth. But what will happen in some cases where if the adrenal glands aren't responding, we don't get that negative feedback loop, and then the ACTH goes up? It's kind of. If you think of the analogy of if a mom is telling her kids to go clean their room and they go and they do it the first time, the mom or the ACTH doesn't need to keep saying, clean your room, clean your room, clean your room. Because the kids go. We get the feedback that the room is getting cleaned. So the mom or the ACTH doesn't need to keep telling them. And so that's a normal, healthy response. But if the mom says, go clean your room, and then the kids don't listen, we are not getting that negative feedback loop. And so mom has to keep saying, clean your room, clean your room, clean your room. ACTH levels go up and the adrenal gland isn't responding appropriately. So the couple things can happen with this whole process. One is that we can have an issue where the hypothalamus isn't telling the pituitary what to do, or we can have where the pituitary itself isn't responding to the hypothalamus, or it could be a downstream adrenal gland issue. So when people talk about adrenal fatigue, it's quite an oversimplification of the process because it's just assuming, oh, everything is low. It must be the adrenal glands. But as you can see, it's a complex process where there's lots of players involved in communicating to the adrenals that we need to be releasing hormone. So we want to look at what happens if your aldosterone. Your aldosterone is high, your aldosterone is low, if your epinephrine is high, if your epinephrine is low, and all of these different things that will provide us information about is this pathway working, and if it's not, where is it stuck? So adrenal insufficiency is actually the more medically accurate term. Instead of adrenal fatigue, we would say adrenal insufficiency. So I have that written here in green. And so adrenal insufficiency, there's two types. There's primary and there's secondary. So primary is where we would see that the cortisol is low and the aldosterone is low. So we're looking, and we see in primary adrenal insufficiency, that these across the board are generally quite a lot lower. And that means the adrenal glands themselves are not producing the hormones that it needs to produce. And so, generally speaking, when we see true adrenal insufficiency, we see symptoms that are commonly associated with, like Addison's disease. So you're gonna have low blood pressure, you're going to have a poor response to stress, you're going to have low blood sugars. And so somebody comes in and they have. They think that they have adrenal fatigue and they have high blood pressure. They feel anxious, they feel wired, they have high blood sugar sugars. It's not an adrenal insufficiency, because, remember, if your adrenal glands aren't working, these other things that they're making won't be working properly either. So true adrenal insufficiency, like Addison's disease, you're going to have low blood pressure because, remember, aldosterone maintains your blood pressure. You're going to have low blood sugar because cortisol maintains your blood sugar, and you're going to have low aldosterone and cortisol on blood tests or urine tests. The secondary cause of adrenal insufficiency would be if upstream things aren't working. So that could be because your pituitary gland isn't releasing acth. It could be because your hypothalamus isn't releasing crh. And so if that's happening, then we would want to do more advanced diagnostic testing to figure out why that's happening. A lot of people want to just say, oh, I have adrenal fatigue, take adrenaline supplements, take adrenal herbs. But that's not going to the root cause. What we're all about is figuring out if you have anxiety, what's causing your anxiety. And we want to look at the details of how your body's actually working so that we can treat the cause. We don't want to just throw adrenal hormones at you because it may not be an adrenal issue. Your adrenals may be rocking and rolling. You may have totally normal or high blood pressure. You may have totally normal or high blood sugars. Your cortisol levels may be really high. And so giving you herbs or supplements or pills that increase adrenal function could cause a lot of issues. For example, I've had people come into my office who've been taking a whole bunch of DHEA because they think they have adrenal fatigue. And then they have all of these symptoms of anger and acne and aggression and their estrogen is too high. And so we really have to just backtrack and figure out what's going on, the root cause. So what we've been talking about today is, is my adrenal gland causing my anxiety? What is adrenal fatigue? And the number one thing I want you to keep in mind is that yes, our adrenals are part of the fight flight freeze response. Our adrenal glands respond to stress wisely and adequately to produce cortisol as well as noradrenaline, adrenaline, that epinephrine kind of response that you get. And that's a really wise adaptive response. In fact, it means that your body is doing what it's supposed to do. And the question is, is it that my adrenals aren't working and they're overachieving, but rather what is going on in my nervous system that's causing my adrenals to respond this way? And so then the conversation changes in regards to what we do about anxiety, what do we do about that process. One thing that you could do if your adrenal glands are really high and we've done that multi step testing is you can use supplements and you can use herbs to help optimize that adrenal response. So if it turns out that it's crashing in the morning, there are amazing plants that can be helpful for that, like Rhodiola, Eleutherococcus, glycyrrhiza, all these different plants that are quite balancing for that to spike that up normally in the morning. And then we can use different things like Ashwagandha and phosphatidylserine if it's too high to push it down. But again, the most important thing for you is to gain a clear understanding of this pathway, how your adrenals work, so that you can treat the cause and get your life back. The number one most effective thing that I've seen in this whole journey is, number one, getting appropriate diagnostic testing. And number two is using mindfulness and looking at your circumstances, looking at what might be feeding into your body, your nervous system responding this way. And so this has been. Dr. Nicole, we've been talking a lot about adrenal fatigue. I want to keep it quick and I want to talk with you more in the private warriors group about how we can manage stress and what we could do about it. But today the take home is that there is no such thing as adrenal fatigue. We do have adrenal insufficiency and there's a different pattern that we're going to observe in adrenal insufficiency and therefore the treatments would be different. So if you have anxiety and you're wondering if your adrenals are the culprit, get appropriate diagnostic testing. Test your adrenal glands. If you test them, make sure that you're doing at least four points. Remember, we have 1, 2, 3, 4, 4 points throughout the day, in the evening. And then you also want to look at the other adrenal factors too. You might want to look at your adrenaline, your noradrenaline. You might want to look at your dopamine and then your sex hormones like estrogen and testosterone. My favorite test for this is a Dutch test. We have this available at my office. You might be able to find it from your integrative clinician too. So go see your doctor. Get really good support. If we can order this test for you can just simply call the office and we'll provide that information below. I'm looking forward to answering any of your questions. Just leave them in the comments. If there are any other topics that you'd like to hear about, please let me know and I'll definitely put together some information for you. And then don't forget to join the Anxiety Freedom One Week Challenge in terms of getting to the root cause of what's feeding into your nervous system. Doing what it's doing is that one week freedom challenge is going to give you free 14 tips for the mind and for the body to help you get your life back. It's totally free. We have a webinar and that's totally free. So utilize these free resources. I'm here to support you. I'm honored to be on this journey with you to learn more about me and my practice. My name is Dr. Nicole Cain and you can go to my website at www.drnicolecane.com. i'm so happy to have been here for you today. Thank you for being on this video and I will see you guys every Wednesday and every Friday. And now I'm going to be popping in the private group and we're just going to hang out on the couch together and I'm going to answer some of your questions about stress. All right, love. So I'll talk to you soon. Bye.