Adrenal Burnout Or High Cortisol? Why You Need To Test Before You Treat

Introduction to Anxiety and Sleep 0:00

Good morning ladies. It's Doctor Sharon Stills, your co-host back with you. And I wanted to have a little chat with you this morning before we kick off you today to talk about anxiety. Anxiety can really take us out of the present moment. Typically, when we're anxious, we are anxious about future events making us leave the present moment moment and so anxiety can really interfere with our sleep. We can wear a layer. We can lay awake at night and not be able to fall asleep. Sometimes we can fall asleep, but we wake up and then the mind is going.

A lot of women report waking up between the hours of one and 3 a.m. and according to traditional Chinese medicine, the circle of tides. That's the time of the liver and liver. Time can be a time of anger. We store liver in our anger. It can also be a time of hormonal imbalance

Hormones, Menopause, and Online Misinformation 1:22

because our liver is intimately involved. So when I treat patients, everyone gets their liver loved up, and if they need their bile and their gallbladder supported, they get that too. So we do bioidentical hormone replacement. But then we put it into a happy, healthy, balanced terrain. And so I wanted to talk to you about anxiety and your adrenal glands today because word on the street, aka Instagram is often misleading, is often wrong, is often just like a little snippet that really has no clinical meaning.

And I was talking to a colleague this morning because I saw something on Instagram that said this was for men, but it said, if you sit in a cold bath, cold plunge, which I love, I have a cold plunge and I'm obsessed with it. That you will stimulate your mitochondria. And since the mitochondria is where testosterone is produced, you will produce more testosterone and you don't need to take testosterone. And in theory, that makes sense. So a lot of things you hear in theory, physiologically, yes, that makes sense textbook wise.

But when you're a physician and you're in the clinic and you're in the trenches working with patients, you really quickly learn that what you hear and what's in theory is not always what clinically happens. And so just like we go through menopause, our male partners are males that we love. They go through and or pause. And so the solution is testosterone for men. Now men we are much more complicated. And I like to think that's awesome than our male friends. So often, you know, a testosterone shot for them and they're off and running.

But women we need the whole symphony. But right now, I just wanted to talk to you about your adrenal glands, because, like I was saying before I went off on my little tangent that a lot of times online we hear that you're high in cortisol.

Why Testing Cortisol Matters 3:31

Too much cortisol is making you have mono belly, it's making you anxious. It's making you not sleep. It's because you're stressed. And that's what we hear. So then we go and try and take something to lower our cortisol without ever measuring it. So I am a huge fan for most things of testing. Not guessing. There are certain things with my 23 years experience that I can figure out just by taking your case, but adrenals and cortisol, you can be fatigued and you can have low cortisol or high cortisol because you're wired.

And so the best way yesterday I talked about 24 hour wet urine testing. Today I want to talk about saliva testing. The appropriate use of saliva testing is to measure cortisol. And so in our 24 hour wet urine test we do measure your glucocorticoids, your stress hormone, your cortisol, the storage of cortisone, all the metabolite aids. So we can see, oh you might have good production but you don't really have a lot of reserves. We measure your mineralocorticoid zero dose, Jerome, which has to do with sodium potassium and electrolyte function.

So we do measure that. But we don't get to see this circadian rhythm. So I always like to add on to get that extra layer of knowledge to really specifically pinpoint how your adrenals need to be loved on. And so in saliva, because cortisol is very bioavailable in our saliva, we can do a four point salivary cortisol test. We take our saliva sample in the morning, at noon, in the evening, and then at midnight, and we get a diurnal rhythm. We get to see, do you look like a ski slope starting high in the morning with your cortisol awakening response and going lower as the day goes on?

Or are you zigzagging all over the place from what you would heard on the internet, you would think your levels are going to be sky high. But I can tell you again, I have a lot of experience. I see a lot of patients. I love seeing patients and most patients, not all, but the majority. By the time you get to perimenopause, menopause,

Saliva Cortisol Testing and Daily Rhythm 5:56

your adrenals have already gone through their sky high cortisol phase and your adrenals now are like, just like I talked about the ovaries being piece out your adrenals are also like, peace out, I love you, but I can't do this anymore. I need to go rest and I see a hammock in my future. And so instead of having super high cortisol levels, you have super low cortisol levels, which could lead to those 1 to 3 a.m. wake ups, which can lead to imbalanced blood sugar, which can lead to the inability to control your inflammation, which can lead to fatigue, which can lead to pain, which can lead to chronic infections, which can lead to a whole host of in a whole host of experiences, including your flatline, depression, anxiety doesn't just have to be high cortisol, it can be low cortisol.

Too often, my treatment for women to get their adrenals back on board is actually bioidentical cortisol replacement. Now, if you listen to everyone out there on the internet, you would think that's insane. I don't want to take more cortisol. I have to get rid of the cortisol I have because mine is destroying my life. But if you don't test, then you're just guessing. And like I said, more often than not, I mean, without a doubt, I don't know how I would say. 810. I would say like eight out of ten women that I run these tests on, they have low levels or they have low levels in the morning, in the afternoon, and then they go high in the evening when they should be low.

And so we need to give cortisol in the morning and at noon and then at night we do need to bring the cortisol down to make the the cycle. I call it the ski slope. We want to start high and ski all day. Get to the bottom of the hill, take a nap, ride the ski slope, the ski lift while we're, sleeping and then, boop, wake up with a nice high levels. And so when we do the saliva test, we can actually really specifically give you what you need when you need it. So we can raise your cortisol when it should be high.

We can lower it at night when if it needs to be lowered, sometimes the rhythm is off. We need to reconnect the hypothalamic pituitary axis, but sometimes the rhythm is there. It's just very, very low. And so to lower cortisol at night, some of my favorite things are sari fast, which is fast for title serene. It's, melatonin. It's l-theanine.

Low Cortisol, Adrenal Burnout, and Symptoms 8:42

Nice calming words then. So there's lots of different things we can do. And if you have heard. Oh, don't worry, when your ovaries go to Hawaii and they're done, your adrenal glands are going to take over and produce all the hormones. I wish that was true, but again, nice. Sounds nice. Makes sense. Doesn't happen by the time you're perimenopausal and menopause. You've lived a lot. And part of the human experience is we deal with stress, right. And so we're not going to escape stress. So you typically even earlier I mean I see it because I treat all ages I see it.

And even younger kids, adrenals are burned out or tired or not producing cortisol. If when your mother was pregnant with you, if she had adrenal hypo function in the third trimester, when your cortisol comes on board, mommy steals it from you. So then babies can be born low cortisol, hypo adrenergic, and so there's a lot that goes to this. So it's not just a simple saying oh cortisol is the the offender in everything. And I need to do things to lower my cortisol. And of course not all medicine comes in a bottle.

Actually a lot of my hormones come in creams. But seriously, on the serious side, we do need to do lifestyle stuff. We need to get our feet on the ground. We need to watch the sunrise when we wake up, watch the sunset. On the flip side, we need to learn our sacred yes. If it's a heck yes, we say yes. If it's not and we give our sacred no. We need to learn to give our sacred no. We need to learn to have boundaries. We need to learn to not burn the candle at both ends. I mean, a lot of us just burn the whole dang thing, right?

And forget about both ends. It's just like going up in flames. And so we really, at this point, if you haven't noticed, if you haven't seen anything written by me, see, I write menopause with a parentheses around the pores. And there's a reason for that, because this is an opportunity to pause and to evaluate and to see what's going on. So we can move forward and we can leave the anxiety, the depression behind. We can get balanced. We can have things flowing and we can feel our best. I love aging because I'm not cray cray like I was.

I was a total drama queen and depressed, anxious.

Lifestyle Support and Hormone Balance 11:21

I mean, I grew up drugging and drinking to handle my depression because I didn't know any other better way. And now, through lifestyle, through using bioidentical hormones, I'm pretty sane. I mean, I'm I have my moments every now and then, but who doesn't? But in all seriousness, it it's it can be done. And I have so many patients who come to me with anxiety with, like I said the other day, were ready to check themselves in because they think they're going crazy. And if they go to the wrong doctor, they may be told they're going crazy.

And I want you to know that the bioidentical hormones, when done properly, when done the way I do them, we're not talking like, oh, like when someone comes in and say they've been sick for a long time, we say, you know, you're not going to get better overnight. Natural healing takes time. You know, you've been sick for three years. You gotta give me at least a while to get your body back together. But with hormones, it's so different. The whole organ things, my whole story is different with hormones.

It's not like, oh my God, you've been depressed for 15 years and you need to give me the next three years of your life. No. With hormones, it can be quick. It can be super quick. When your body gets the hormones it needs in the right forms and gets balanced, your body is grateful and it lets you know. So I want you to have hope. I want you to know that if someone has told you you're crazy, you need the birth control pill, you need an antidepressant or an anti-anxiety. They're probably not the person you want on your team.

Now, I also want to say I'm a doctor, but I'm not your doctor unless my patients are listening. So if you are on medication, you should not stop your medications because you hear some good talk, some good interview. You need to check with your doctor. Going off pharmaceuticals for mood disorders abruptly can put you in a serious situation and not a good one. So please take care of yourselves. But remember, adrenal saliva testing can give you a really good story on what's going on with your adrenals, and that can be a root cause of anxiety, depression, ADHD, all the things.

So I trust that this has been helpful for you. Enjoy all the other talks again. I'm your co-host, Doctor Sharon Stills, and it's truly my honor, my privilege. I'm sending you all so much love on your journey, and I trust that you will find your answers.