HPA Axis and Chronic Stress

Welcome to the Balanced Body Podcast, where Sherry Griggs, owner of Balanced Body Health and Wellness in Omaha, talks to us about health, wellness, and balancing hormones. We are here with Balanced Body Health and Wellness Podcast with Sherry Griggs, hormone expert extraordinaire, and a guest today, Tanika Gravely, with Tag Family NP. Did I say that right? You did.

Yeah, you got it right.

Yes. Awesome. And I'm actually kind of excited because today we're going to be talking about a bunch of stressful things. But when I wrote this down in our quick little notes, I wrote down adrenal fatigue and immediately found out that that's wrong. So we're talking about chronic stress and things tied to hormones.

Right.

And where do we even start? So why is— what, what is adrenal fatigue or chronic stress, or what's the difference between the two sayings right then and there?

Right.

Well, that's what I brought Tanika on for. She's out of Buffalo, New York, and she knows a lot about this. And I thought, well, let's just have an expert tell us about it.

Well, I mean, Tanika, come on, you gotta jump right in after that one.

Thanks for the— that introduction, Sherri.

You're welcome.

So, what I like to do or how I like to explain this to my patients is just go through basic definitions and explain what stress is and then explain what the misnomer of adrenal fatigue is because that's what it was really known or called initially. And we had to realize that that had A whole separate diagnosis and treatment plan. So now it's called HPA axis dysfunction. medical issues if not addressed. Keep in mind, though, healthy stress, like let's say you're taking an exam or planning for a wedding, that actually helps maintain homeostasis, which is just balance within the body. affect the adaptive mechanisms that we need when you have that acute stress that the body kicks in, that fight or flight versus the feed and breathe.

Mm-hmm.

So as a result, the endocrine system can struggle to respond effectively and optimally, especially if it's dealing with chronic stress. I like to say that stress is definitely subjective. What one person might think is stressful, someone else might be like, oh, that's not bad, you know. But stress can also be internal or external. Either way, if it's chronic, it can have a contributing factor to chronic illnesses, immune deficiencies, or even inflammation throughout the body. Mm-hmm.

This all makes sense to me the way that you're saying it, but I'm curious, we're talking about just everyday extra stress. So like chronic stress would be like, you said fight or flight. So I'm thinking like I almost get into an accident and then like my brain goes crazy. You're talking about like day to day in and day out crazy stress.

Yeah. So there's different types of stress. So there's a healthy stress, which is a positive— that leads into a positive outcome. So that's where your body can quickly recover after experiencing that type of stress. So how you just said you've almost gotten into an accident, you get that adrenaline rush, but then eventually you calm down, right? And now you're out of that acute stress phase. There's tolerable stress. That's where The stress is manageable, but with some type of external support. So during that type of stress, you can have complete recovery as long as that stress does not persist. Then there's toxic stress. This is the type of stress that exhausts both mentally and physically. It can make recovery difficult and Regardless if you have— or that's like with or without help from the external sources. So that toxic stress is where you'll find yourself getting into some serious trouble because that will become long-term chronic stress.

So then it's almost like— and you had said that it's per person because everybody has their own level of stress that they can kind of take in and out. If I was to take it to the extreme, say I'm in jail somewhere and being tortured, chronic stress. And then there's levels below that, also chronic stress. And then there's like a gray area where it's like in between, as long as I can get out of jail and not be tortured anymore.

I hate to bring it to the extreme, but that's how I think.

But you know, you think extreme, right? So yeah, now if that were to stay with you for a long period of time, continuous, like Tanika is saying, chronically, meaning constantly all the time, then yes. And Tanika, can you explain to us, you brought up, you said HPA axis, what is that?

So it's the hypothalamus-pituitary axis. And that dysfunction, if it's primary adrenal dysfunction, that can be another term for Addison's disease, which is It's like a rare autoimmune condition. I think sometimes that's— it's extremely rare. I think it's linked to TB or something like that.

Mm-hmm.

Secondary adrenal insufficiency occurs when there's traumatic brain injuries that could affect the pituitary production. So you have the hypothalamus that communicates to the pituitary that communicates to the adrenals. So, there would be a break in that communication. And then there's tertiary, which is really associated with the abrupt cessation of corticosteroid use that can completely deplete production of CRH that will affect the entire HPA axis.

Huh. Wow.

So, it's just the communication from one gland in the brain to the other to the adrenals. In situations like that, that's why we don't call it adrenal fatigue because that will have a completely different diagnosis, treatment plan, and follow-up as opposed to HPA axis dysfunction or insufficiency.

Okay. And we're talking about this because This is talking about the motor of the car, right?

Yeah.

And I don't know, Tanika knows about the car. We didn't bring the car up again today.

We didn't bring up the car. Oh my God.

Tanika, so here's how we talk about hormones. Hormones, think of it like a car. Cortisol is the engine of the car. So I could give you 4 new wheels, estrogen, progesterone, testosterone, and DHEA, but if your engine's not running right, it's not gonna—

Nothing else matters.

Right? And then the thyroid hormone is your transmission. And that needs to be going the right speed. 'Cause if it's too fast or it's too slow, even if your motor's running right and you have all 4 wheels, things still aren't going as efficiently as they could. And when I say all 4 wheels, so if we get 3 good ones and one that's bad, it's still gonna go. It's still gonna go. It's gonna hobble along. And so that's how we talk about how all the hormones have to work together.

So cortisol is a huge one.

That's a good one. Yeah, isn't that great?

It really helps me understand what's going on with hormones in general. That's a good one. I like that.

So the adrenals are what supply the cortisol hormone, correct?

Mm-hmm.

And so when you have either an HPA axis dysfunction or adrenal fatigue or whatever, something's wrong with our cortisol level, right?

Yes.

And what could that look like? Like, would it be too high or too low, or what happens?

So that's one of the differences too between, you know, just having chronic stress to where your body decides to shut down that system because it's like, oh, we don't want chronic inflammation, so we're going to shut this off. So this is what your body is trying to do as opposed to your actual adrenals not functioning correctly. And producing the cortisol. So that's when you would actually need cortisol.

Oh, so then with all this, I, you know, my example doesn't necessarily make sense because it's external forces are kind of making us stressed. Can people internally be dealing with this constant stress just because their engine is wrong? Did I get that right?

Engine? Engine.

Yes. To be honest with you, some people can be dealing with this and have absolutely no idea. Some people can be dealing with this and have blood levels drawn and still have no idea because your sex hormones can look fine, your thyroid hormone can look fine, and you still can be dealing with this dysfunction. So what we like to do in the world of functional medicine is do extensive, extensive personalized questionnaires or intake so that we can get a general idea of the type of symptoms that you're having. When we do tests, of course, we'll test your hormones. We'll see if you're having any kind of gut dysfunction because— We all know that, you know, the gut and hormones are a huge overlap. The gut and the brain have a huge overlap. So we definitely want to make sure that we're optimized there. And then with other testing, it's not ideal to do a blood test to check for the efficiency of the adrenals or the cortisol. And that's primarily because with serum testing, it just has the inability to capture what we're looking for in the circadian patterns. So we can't tell if you have that initial peak in the morning and then that nice decline as the day goes on. And then at night when it's time to go to bed, That's when your cortisol should drop, and then your melatonin kicks up. So, if that cortisol does not drop, your melatonin doesn't kick in. You kind of sleep crappy if you get to sleep at all, or you may sleep for a couple of hours, and then you're awake 2 o'clock in the morning when you get that cortisol rush. And, you know, life's not fun. So, um, we definitely will use serum or blood tests to Check your other hormones, but not necessarily your cortisol. There's another test that can be done. It's the hair mineral analysis. I'm not sure if you ever used that, Sherri.

I have not. I do saliva for cortisol testing.

Yeah. Yeah. That's another good one. That's the one that I usually turn to, but I know some other providers are starting to use the hair mineral analysis test. There's extensive training behind that that I haven't taken because we can't use that test in New York State. But I know that there are other— yeah.

How would they get the rhythm off of that though?

That I'm not sure. I have to look into it. I just started reading about it, but I know that the hair tissue analysis is supposed to give you hormone results. It's almost like a full body test. So I definitely am interested in reading up on that, but I wanted to pick your brain to see if you've ever used it or not. So that's something that we have to do a powwow on.

Okay.

But the saliva testing, which I think is the most popular one, it's also recognized by the American Endocrine Society. That gives a comprehensive view of the adrenal hormones and the circadian rhythm because it allows us to just track it throughout the day. And I don't know if you've ever used this. I've never used it personally. There's a Raglan's test with the blood pressure where you sit down, take the blood pressure, then you stand up immediately, take the blood pressure again. And then if there's a drop in the systolic pressure, then that can indicate adrenal fatigue. So it's like a home test that—

Oh, interesting.

Some telehealth providers would use. I never use that because I figure it can, you know, that can be anything, but maybe that's something.

I wouldn't think it would be as accurate.

Right.

As actually doing a 4-point saliva test.

Right. Right.

Which is where we collect the saliva 4 times during the day. So when Tanika talked about it should be high in the morning. So we'll do it first thing when you get up in the morning, then around noon, around dinner, and then at bedtime to see that it's in the right rhythm, right? That it's higher in the morning and then it comes down.

Okay.

Into the night.

So then that— yeah, that was kind of something I was thinking. I kept trying to say, don't think about a question while Tanika's talking, just listen, just listen, just listen, because you probably answered this while I was saying that in my own head. But just in case, so are ways to tell that you Because, because you, you said a couple of things. One is that it's our own personal stress levels that we're dealing with. So only we really might be able to tell once we're kind of tuned into maybe I'm dealing with this dysfunction. Are there ways that I can kind of think that this is probably something that might be tied to my hormones? Like you had said, spike in the morning, feeling it go down, and then you can sleep through the night. Like if I'm not sleeping well at night, that could be a part of this, or I could just not have that spike in the morning. I mean, is that what I would be looking for?

Yeah.

It could be, but we'd have to do all the testing because hormone— the endocrine system is so complex. We can never just take a finger and point at one particular thing. It's a big— it's a 1,000-piece puzzle.

But that's what I want.

But that's what it's hard, right? Because you can't just fix one thing. It's got— you've got to look at all of it.

Yeah.

Right?

Everything.

And then we say insulin is the The overall umbrella, but yeah.

Interesting.

Yeah.

Okay. So those things could be the red flags or like the warning lights on my dashboard.

Mm-hmm. Mm-hmm.

And then maybe this is something to be then tested, but then like, as you're looking through the tests, because I'm sure, uh, Tanika, you do the same thing or something similar to what Sherri does where she's checking all of the different hormones at the same time, because you said it's such a Such a complex system. You need to be kind of looking for many different things. Once you pinpoint that this is the ADA access dysfunction, HPA, HPA. I'm trying.

So many acronyms.

So many acronyms. AHP, HPA, HPA. Okay, okay. HPA dysfunction. So then we pinpointed it. It's, it's the testing to make sure everything is not really in my personal liking. How do we fix— is there a way to fix that? I mean, is that a, is that a dumb question to ask?

It's not a dumb question. No question is dumb. Okay, good. So what I like to do immediately is Dive into lifestyle changes before. I mean, obviously, you're going to give them, you know, a treatment plan, but I think lifestyle changes and recognizing that is a huge, huge contributing factor to getting the patient through this. And lifestyle changes that can include diet, exercise, Good sleep hygiene, reduction of blue light when it's time to go to bed, and just the little things. Don't watch TV or be on your phone 2 hours before you go to bed. If someone is a little worse off or having worser symptoms than someone else, I would even have them get the light that you can kind of turn down as the day goes on so that they can adapt their sleep. surroundings and let their body know that, okay, it's close to nighttime, close to bedtime. Set a bedtime, set an alarm in the morning, and just kind of get into a routine habit. So, that would be lifestyle changes. Stress management. So, definitely trying to identify immediate stressors. Sometimes we can be stressed and not know it. And sometimes you can ask them, are you stressed about anything? Well, no, I don't think so. And Sometimes you could talk them through and they're like, oh, maybe that is stressing me out a little bit. Or sometimes they have no idea what the stress is. So we would try to incorporate things like meditation or yoga or just taking time for yourself throughout the day. Some of us, I can speak to nurses or providers, your day is just constantly going, constantly going. And before you know it, it was 8 o'clock and now it's 6 in the afternoon and you haven't had lunch. You haven't— you know, had a bathroom break and you're just constantly going, that can be a problem. So you have to—

And I know when it's your life, that's one of those things you can't really, you can't really tell that it's not a great idea to have an energy drink and drive in rush hour traffic. Right.

Yeah. So that's a coffee.

That's no good. This is news for me.

So those are things that we want to definitely bring to their attention because, like you said, some people aren't even aware that these things are going on or that these things are not as healthy for you as they thought. The other thing then would be to get into supplements, adaptogenic herbs, and my favorites would probably be ashwagandha.

Ooh.

Licorice, depending on, you know, if they're not on any other medications that contraindicate that. Some people do well on licorice, and rhodiola is another good one.

She doesn't mean red or black licorice that you eat. This is not a sugar thing.

I was just about to go and get my black licorice and say, so this is prescribed right now?

This is prescribed by my hormone specialist.

Slickerish like the root or whatever.

Yeah. Okay.

Yeah, I like ashwagandha. Now, do you, um, subscribe to going out and finding your own herbs, or is it something that you would— when you have prescribed in the past to someone, you have like a supplement that you're giving them?

Yes, I like to use, um, I'm actually partnered with a few supplement companies that I've vetted and they've been researched and they use good quality supplements, things without all the extra fillers and probably things that have endocrine disruptors or estrogen disruptors in them. So I do try to— what I like to do is just say, here are the supplements that I recommend. They usually go for them.

Uh-huh.

As long as I give them the name of the supplement, I rarely have anyone just go grab a supplement off the shelf because again, I explain to them that we're not really sure what are in those other supplements and definitely stay off the research lab websites and some of the Amazon products because you honestly don't know what you're getting.

Sherri and I talked about that just the other day when we were talking about Hashimoto's because The supplement that was being prescribed was one that actually had gluten in it.

Ah, that was a prescription. Yes.

A prescription.

A prescription thyroid replacement that has gluten in it and you shouldn't have gluten when you have Hashimoto's. Yeah.

And if this is the first time you're tuning in, go back and listen. This is fascinating. Okay. So we talked about HPA. We talked about how it's stress-induced, but also not necessarily always external stress, even though it does sound like sometimes external stress can be A part of the situation. I mean, your lifestyle really kind of does dictate how you deal, how you deal with stress even, right? Because sometimes people just deal with stress all the time and they're okay with that level. Would you say that that's right as well? Like, if you're in a very— you had brought up like a nurse. So I mean, if you're a nurse or a doctor or EMT or something like that, I mean, you're dealing with stressful situations constantly.

But I think like Tanika brought up is that they don't realize it. They don't realize what it's doing to their body internally, working or living in that lifestyle all the time.

Okay.

So they're not really aware of it. So what kind of symptoms would somebody— right? So how might you know that you are— that your lifestyle is hurting you in that way internally?

So I would say, and it's honestly the— some of the symptoms that I give you, you're going to say, oh, well, that could be any Hormone, because they kind of overlap. Those that are just chronically fatigued, or I should— you know what, let me back up for a second. If you wake up and you're tired, right, that can be cortisol, or that can also be inflammation, or that can be iron deficiency anemia. That can be a number of things. If you wake up and you're fine, and then a few hours later you hit that slump, That's probably adrenal— well, not adrenal insufficiency, but HPA. I told you I was going to—

But it really is your adrenals. We just have to have a fancy word for it.

Right. So that's usually one of the assessment questions that I do ask. Or if you're able to fall asleep at night and then you wake up and you just can't get back to sleep, that's another one of the That's one of the red flags that kind of goes up that I point to and say, hey, maybe we need to do that saliva testing to check your cortisol levels and see how that's going. I will say too, when we do the cortisol testing, we discussed earlier, you want that initial spike in the morning and the decline throughout the day. And then, you know, You want it low at night. If you have the saliva testing done and you just maybe have a small spike and then you kind of flatline throughout the day, that's no good at all because that's when, you know, we can tell that you're at risk for more serious effects of like cardiovascular issues. That's actually— I'll send you the study. I can't remember the name of it, but it's linked to higher increase in cardiac arrest. So, you definitely want to make sure you have that spike with that decline because if you have that flatline, that's definitely placing you at a higher risk for cardiovascular issues.

Oh, yeah. Okay. It's good to know.

Because like when Tanika said earlier, good stress. We need cortisol. If you get to the point— in fact, I have a graph in one of my talks about it that if you get to the point where you don't have any, that's called death.

Yeah.

So you don't want to achieve—

No cortisol at all. It's not good.

No cortisol means—

Nothing.

But you've got your stress. So no cortisol, no stress. I mean, if you're looking for a glass half empty, the full thing.

Well, not necessarily because self-distress, but your body just can't react to it.

Oh man.

It can't give you what you need.

Oh.

And that's why we said you need that homeostasis, that perfect balance.

Perfect balance.

That's right.

I like that. Well, so say somebody is listening and they're dealing with a little bit of a stressful situation, but then they look back and they're like, okay, well, I kind of seem like I'm dealing with a lot of extra stress. Or just constant stress. Is that when they should call, or is it a different time, or is it, you know, when is a good time to schedule 15 minutes and just kind of talk through some of the situation?

Yeah, if you do have symptoms and you're feeling chronically stressed, that's definitely your body saying, hey, that's, you know, your body gives warning signs, right? Nothing ever just happens out of the blue. So, you'll be fatigued, or you'll have foggy brain, or you'll have, Weight gain that you can't get rid of, or that your body gives you all these little clues. It's just up to us to understand what our body's trying to tell us.

Mm-hmm.

And it's up to us to recognize what these changes are. So if you're having all these little— your body's leaving you these little breadcrumbs, then that's when you definitely give a call and, you know, hey, this is what I've been experiencing. We set up the initial call. We go through all your symptoms, and just by that, we can pretty much say, you know what, I think we should test for this, or this sounds like what you're going through, and then we'll move forward from there. But definitely do not ignore the little signs that your body's telling you. And that's the difference too between a functional medicine provider and someone who practices Western medicine, because if you go into your primary care provider, They may say, hey, nothing's wrong at all. Or you may end up with some Xanax or Zoloft or some type of depression medication. Oh, you can't sleep? Well, let's give you something for sleep.

Right. Because we're treating— because they treat the symptoms, not the cause.

Yeah. That's right.

Right?

Medicine's all reactive lately.

And then once your body gets used to that and you say, hey, this isn't working, they pile— they add something else onto it. Well, take this one as needed. Schedule that one. Take this one as needed. Nobody's really looking for the root cause of what's going on. So, I would definitely say if you are experiencing fatigue, trouble sleeping at night, if you're— even if you're in a work environment that's high stress, that's definitely something you want to look into. Okay.

I want to say thank you, Tanika, for giving us all of this great information. I really appreciate you joining us.

No problem.

If you are listening and you're in the Omaha, Nebraska area, uh, you can reach out to me, Sherri Griggs, at Balanced Body Health and Wellness at www.balancedbodymedical.com. But if you're listening and you are not in my area, then you need to reach out to Tanika. Tanika, how can they reach you?

I am at www.tagfamilynp.com. That's my website. And We can have a consultation, uh, discovery call, or, you know, if you're ready to just take the plunge, we'll have the initial consultation, go over your symptoms, and then we'll kind of take it from there.

Because Tanika does it— you do it remotely, right? So you work with people all over.

Yes. So I can prescribe in New York State. If you're not in New York State or Nebraska, then, uh, you can reach out to me and we can I can still get your labs ordered and I can do an interpretation of your labs and give you recommendations.

Well, that's awesome. Yeah.

I love that.

Well, cool. Well, thank you both so much for talking about stress. I feel less stressful about knowing more because it's all the more you know, right? Right.

Fear of the unknown. That's what they call it.

Totally. Yeah.

Stress of the unknown.

Mm-hmm.

Yeah.

Yeah. Well, wonderful. I so appreciate the time, Tanika and Sherri.

And thank you guys. I really enjoyed this. We got to do it again.

Yeah, absolutely. This has been the Balanced Body Medical Podcast with Sherri Griggs, owner of Balanced Body Health and Wellness. If you're looking to find Sherri, go ahead and look for the website Balanced Body Medical. If you're looking for the business and you want to find Sherri at her office, you can find her at 10815 Elm Street in Rockbrook Plaza.

Thank you.