Your Adrenals and Your Hormones – The Missing Link

Dr. Sharon Stills

Hello everyone, and welcome back to the Mastering Menopause Transition Summit. I am your host, Dr. Sharon Stills, and I am truly honored and humbled that you are taking some time to be here with us today and learn what you can do, whether you are before menopause, in the midst of menopause, after menopause, we are talking about things that apply to you no matter where you’re at on your hormonal journey. And so I’m excited you’re here. We’re gonna have a great conversation today. We’re gonna be talking about the adrenal glands, and if you don’t know about your adrenal glands, or aren’t already in love with your adrenal glands, and treating them like the special part of your body they are, then hopefully, by the time we’re done talking with our special guests today, you will be board, an adrenal fan. So my guest today is Dr. Deb Matthews. She’s known as the Happy Hormones Doctor, so I had to have her on the summit. How can we not have the Happy Hormone Doctor join us? And she is gonna speak to us all about the adrenal glands and why that’s important when you are thinking about your hormones. So welcome, it is so nice to have you here. Thanks for joining us.

Deb Matthew, MD

Ooh, thanks for inviting me.

Dr. Sharon Stills

You are so welcome. So I’d love if you just tell everyone you’re the Happy Hormone Doctor, but just tell us a little bit about you professionally, and if you wanna share anything about your personal story, that would be fabulous as well.

Deb Matthew, MD

That would be great. I didn’t used to be so happy. I went for years feeling exhausted all the time, and my favorite hobby was napping. In fact, when my kids were little, I used to plan my whole day around how I was gonna get them to all fall asleep at the same time, so that I could take a nap, and a lot of times what that meant was I would strap them all in the car seats, take them for a driver on the neighborhood till they fell asleep, and then we would all just sit in the car in the driveway, snoozing because I was so exhausted. And the thing is, I didn’t understand what was wrong with me because there was really nothing in my medical training that helped me understand what was going on. I just thought, “I’ve got kids, of course. I’m a mom, I’m tired,” but it wasn’t normal, and eventually I got to the place where I wasn’t just tired all the time, but I was really irritable, and I was screaming at my kids over little silly things, and then I felt so guilty for being such a horrible mom, and my husband is the one that had to put up with my Wicked Witch of the West impersonation. He didn’t know what the heck to do with me. And what changed for me is I read a book written by Suzanne Somers about women’s hormones. 

And I didn’t wanna read the book because, as an MD, as a medical doctor, we don’t wanna get our information from celebrities. We think we learned everything we needed to know at medical school, and the reality is when I read this book, and I read all these stories of women who felt just like me and how much better they felt when they got their hormones imbalance, it blew my mind, and all of a sudden I realized that my adrenals were important, and they weren’t working. In medical school, we only know about diseases, but my adrenals were so shot that it was so exhausting for me to get through my day. And there were some other things going on, too, and maybe as we go, we’ll kind of fit some of the pieces together. But the bottom line is once I understood what was wrong, I was able to find solutions. I got my energy back, my kids got their mom back, my husband got his wife back, and I got my life back, but I couldn’t go back to just writing prescriptions all day long, which is what they taught me to do at medical school. It just didn’t make sense anymore, so I completely retired from my old practice, changed everything, and now for the last 15 years, I’ve been working with men and women to help them get their hormones back in balance so they can get well, get off the prescription drugs, and love the way they feel.

Dr. Sharon Stills

Mm, I love that, and I was chuckling ’cause my story about treating with hormones also came from a patient giving me that Suzanne Somers book and I had a similar reaction about it, so I think that’s awesome. And I applaud you. I love when MDs like yourself just really get it and are so brave and are willing to say, “I’m gonna just stop and do a total remake,” and that’s so inspiring for the women listening. At any time, you can just stop how you’re feeling or how you’ve been treating yourself or how you’ve been thinking about your health, and you can start to do a total remake from learning what we’re talking about here. So I know I asked you to speak about the adrenal gland today. 

You were speaking about them at a medical conference that we were both at, and I thought what an important topic, and it’s really important to me that we really widen the conversation. It’s one of the reasons I wanted to put together this summit so we widen the conversation about what it really means to master the menopause transition. Yes, the sex hormones are amazing and great, but there’s so many other ancillary things that are just as equally important and the adrenals are one of them. So let’s just dive in, adrenals. For someone who’s listening, who really doesn’t even know or has heard about the adrenals, what would you like them to know for starting?

Deb Matthew, MD

Yeah, our adrenal glands are about the size of walnuts, and they sit on top of our kidneys in our back, and they make our stress hormones. So they make adrenaline, that’s like our fight-or-flight response, and they make cortisol, which is also our main stress hormone. It’s kind of like long-acting adrenaline. So when we’re stressed, our cortisol levels go up, and that’s really important because cortisol is the hormone that helps us cope with stress. It’s a good thing. The problem is when we have stress day in and day out, then our cortisol levels can end up being chronically elevated, and when our cortisol levels aren’t right, that’s when we start not feeling good, when it becomes a lot harder to cope with stress, and it’s important because cortisol is a regulating hormone. 

It regulates lots of other things besides just stress, so we’re gonna talk about some of those other things, too, but it’s a really important hormone. In my practice, as I said, I work with women and I work with hormones all the time, and if we just focus in on their estrogen levels and their thyroid and the other female hormones, and we don’t take cortisol into account, a lot of times we just never get all the way there. And in fact, I would argue that most of the women that end up coming to see me because they’re having any kind of menopausal or perimenopausal symptoms, most of the time we find adrenal problems because when you’re adrenal glands are outta whack, it’s messing up the other hormones, you are the one that ends up having the symptoms of menopause. So adrenal glands are really, really important for us to be talking about.

Dr. Sharon Stills

Exactly, if your adrenals aren’t functioning, and the truth is, I’m sure you see it in your practice, too, not many women have functioning adrenals because we just live in this sea of stress, all these different stresses, and so it is, it’s one of the foundational things. So if you’re listening and you haven’t had your adrenal glands evaluated, right after this, you’re gonna wanna have that done, for sure. So what would a woman be experiencing? Is it just fatigue? What are some of the things?

Deb Matthew, MD

Well, so let’s talk about the fatigue for just another moment, if we can, because there’s a pattern to the fatigue that I think is really important, and I think a lot of people are gonna recognize this. The first thing is cortisol has a natural circadian rhythm and that circadian rhythm is so important to our health. And what’s supposed to happen is cortisol levels are supposed to go up in the early hours of the morning, and then they’re supposed to go down over the day and they’re supposed to be low at night. So that increase in cortisol in the morning is what’s supposed to make your eyes pop open and you leap from your bed ready to start your day, but what happens to a lot of people is the alarm clock goes off and they’re still exhausted, and they press snooze, maybe a couple of times, and eventually they get their body out of bed, but their brain’s not all the way turned on yet, and a lot of people have to reach for the caffeine because caffeine gives us a little boost of cortisol and wakes up our brain. And I remember back when my adrenal glands were really toast, my son, who was really little at the time, would wake me up super early in the morning, 5:30 in the morning, and my brain was not ready to be awake yet. 

So I would have to get up with him because he was little. We would sit on the couch, I would turn on the TV ’cause I couldn’t function, and there was nothing good on at 5:30 in the morning at that time, but I would sit on the couch beside him with my eyes closed ’cause I was so desperately exhausted. And as a little kid, he would sit there, you know how they do and try to pry my eyes open to keep me awake, but I could not function. And then by seven o’clock, suddenly then my brain would wake up and I was able to get up and I was able to function. So for me, that was shifted kind of early, but for other people, sometimes you can’t really get going and get started until nine or even 10 o’clock in the morning, which makes life really, really difficult if you have to get up because you gotta go to work or you gotta deal with your family. So not being able to get up and get started in the morning is one of the common patterns that we see for people who have adrenal problems. And then the next thing that we see is, finally, you get moving and you’re going for a while, and then the bewitching hour hits, 2, 3, 4 o’clock in the afternoon, everything just kinda crashes and burns, and that’s when you just gotta have a nap, or more coffee, or sugar, or something to get you through to supper time. And when I think back on this, that exactly correlates with when I had to be picking my kids up from school. 

So me, and I was not the only other mom in the carpool line with the same problem, would be sitting there nodding off, and how embarrassing would it be if you drive into the car next to you in the pickup line at two miles an hour because you conked off and fell asleep. But that afternoon slump in energy is another really common thing that we see with adrenals. And then usually starts to get better around supper time, but sometimes early in the evening, 7:30, 8 o’clock, earlier than you would normally go to sleep, we feel tired again, like, you’re falling asleep on the couch watching TV, but sometimes doesn’t happen for everybody, but sometimes if you stay up late enough, now, 10 o’clock at night, all of a sudden your brain wakes up, now you’re ready to go and you’re getting the best work of the day done, but, of course, then, when you wanna fall asleep, it’s hard to fall asleep. And when you finally do fall asleep, then you wake up at 2:00 am or 4:00 am and you don’t get that good restful sleep, and the next thing you know, the alarm clock’s gone on again. So this up and down pattern over the day is really classic for adrenal problems.

Dr. Sharon Stills

Mm, perfect explanation of all the… I always talk about it with the patients who, you’re like, “Oh, it’s nine o’clock. I think I’ll start mopping the bathroom floor and the kitchen floor,” and you get that second wind, and you’re just like, “Let’s go for it,” and not a good time to be doing that. So that is so… So do you, because it is so classic, what would you say to the women listening as far as how they can understand? Because there is this extreme high level of cortisol, but then there’s also can be where you’re just burned out and you’re not producing cortisol. So how does someone know?

Deb Matthew, MD

That’s confusing because high cortisol is not good for us. So some of the other symptoms of high cortisol is gaining weight, especially right around your midsection, and gosh, don’t we all hate that weight on our bellies? So gaining weight, mood changes, anxiety, depression, food cravings, high cortisol can push or drive our blood sugar higher and push us towards diabetes, it can cause bone loss and push us to osteoporosis, it’s bad for our short term memory and even pushes us towards dementia, so high cortisol is not good. Over time though, your body can’t keep pumping out all that cortisol and things start, cortisol levels can start to drop inappropriately to the point where now you don’t have enough cortisol to make it through the day, and that’s where we just feel exhausted and overwhelmed and burned out, and every little thing feels exhausting. Like, just getting the groceries home and unpacking them and putting food on the table, it’s just exhausting. And sometimes it feels like just too much. 

Like, we just wanna crawl back into bed, pull the covers over our head and make it all go away because we just can’t deal with it, so that’s the burnout. So those are kind of the extremes. You can have too much cortisol, you can have not enough cortisol, but what we find a lot is maybe the overall amount of cortisol that you’re making is okay, but you’re not following that normal circadian rhythm. So instead of having high cortisol in the morning and low cortisol at night so you can sleep, it gets flipped around backwards, and now you’re low in the morning and you can’t get your butt out of bed, and it’s high at night and you’re mopping the bathroom when everybody else has gone to bed in your house. So that’s why it’s confusing. It’s not just that it’s high or low, it’s actually, the most important part of this is that circadian rhythm needs to be on track.

Dr. Sharon Stills

Exactly, exactly, I always explain the circadian rhythm to patients as a ski slope. And so in the morning, you’re up, you’re ready, you’re ready for action, you’re at the top of the hill, and then as the day goes on, you’re skiing down the slope, and so by the time it’s night time, you’re done, you’re exhausted, you’re ready to go to bed, and then while you’re sleeping, you’re kind of riding the ski lift, so you’re ready to go again. And I see the same thing as well, where often there is enough total cortisol, but it’s wonky and it’s high when it should be low and it’s low when it should be high. And so what is your favorite way to help patients understand that, to test to see what their cortisol is doing?

Deb Matthew, MD

Well, testing for cortisol is interesting and important, but unfortunately it can sometimes be really frustrating for women because if you march into your doctor’s office and say, “Oh, I just listened to this interesting talk and they were talking all about cortisol, I’m sure I must have adrenal problems,” your doctor is not likely gonna be very helpful for you because what we are trained to do, if you go to an MD, I’m talking about here, NDs would be much better at this conversation, but if you go to like a regular family doctor, a regular gynecologist, what we were trained to do at medical school is we were trained to look for tumors, or we were trained to look for an autoimmune condition where your adrenal glands are completely broken, they cannot make cortisol, which is a life threatening condition. Those things are rare. This is super common. But if your regular doctor is just looking for tumors, they’re not gonna pick it up, and they’re not likely even gonna bother to wanna do the test. 

A blood test, which is sort of the most obvious thing that people think about when they think about a lab test, a blood test isn’t really the best test for this because we’ve just finished saying, at different times of the day, your cortisol is gonna be a different number, and so it completely matters at what time of the day you would get your blood work done, you’ll get a completely different value. So at least if you get a blood test done, it needs to be at eight o’clock in the morning because that’s when, when we have the norms, the values for it, but we can miss so much because all the rest of the stuff going on in the day, and then even just the stress of getting to the lab and get their first thing in the morning and get a needle in your arm, sometimes that can give you a little bit of a boost of cortisol, and so the test result may not be the most accurate way. So what I prefer is to do either a saliva test or a urine test, and the reason is that you can do this yourself at home, and you can collect samples at multiple different times over the day so we can see that ski slope and we can make sure you’re high at the right time and you’re low at the right time. And urine tests and saliva tests give us slightly different information, so there’s pros and cons to both, but they both work well, and both of them are good choices.

Dr. Sharon Stills

Could you talk about the pros and cons?

Deb Matthew, MD

Sure.

Dr. Sharon Stills

That would be interesting.

Deb Matthew, MD

Yeah, okay, so when we’re doing a saliva test, we can do a sample first thing when your eyes open, like even before you get out of bed, you can sit there and collect the saliva, and then we can do one 30 minutes later, and then 30 minutes after that. And so that can measure, what we call, the CAR, the cortisol awakening response ’cause we wanna see that within 30 minutes after you wake up, your cortisol level should double, and that’s a really important factor for predicting how well you’re gonna be able to cope with stress. And then we can look at it in the afternoon and before you go to bed, so we can get these multiple markers and make sure that you’re following the normal circadian curve, and it’s simple, it’s easy to collect, it’s cost effective, so that’s a good way to do it. If we do it in a urine test, same idea. We get you to pee on these little strips. It’s almost like doing a pregnancy test. You just pee on the little strips multiple times in the day. First thing in the morning, it’s telling us about the cortisol that you made at night when you were sleeping, and then we get you to collect another sample a couple of hours later, that’s gonna show that rise in cortisol that happened right after you woke up, and then we can do it later on in the day to show that it’s going down, and in a urine test, we can look at your urinary metabolites so we can see how your body is processing the hormones, and we can get an estimate of the total amount of cortisol that you made, and, what we call, the free cortisol, which is, basically, what’s left over. 

They’re supposed to match. You should have either high or low or the free, and the metabolites should match, but sometimes there’s a mismatch. Sometimes you’re making a ton of cortisol altogether. The total amount is high, but the free fraction, which is the amount you feel, is low, like there’s nothing left, and it’s not that your adrenal glands can’t make cortisol. You’re making a ton of cortisol, it’s just you’re using it all up and there’s nothing left and that’s why you’re exhausted. And there are reasons for the mismatch, but it gives us information to know what we need to do in order to start fixing it, so it gives us really good information.

Dr. Sharon Stills

Great, thank you. That’s very helpful. And so I would imagine women wanna know, because we said this is so important, how is the adrenal gland interacting with the other organs of the body? What is the impact?

Deb Matthew, MD

Yeah, so it’s a regulatory hormone. It is regulating our sleep-wake cycle, it’s regulating our blood pressure, our blood sugar, it’s regulating our immune system, and that’s the connection between why when we’re stressed, our immune system doesn’t work as well, but it’s also regulating all our other hormones. When we are stressed and cortisol goes out of whack, it impacts whether or not we’re ovulating regularly, and so that impacts whether or not we’re making progesterone. So for premenopausal women and perimenopausal women, when we’re really stressed, we don’t always make as much progesterone as we’re supposed to, and that’s the female hormone that is calming, so we feel relaxed and chilled out, and we sleep soundly through the night, and we’re not screaming at our kids and our husband, and then feeling guilty for being a horrible mom. Cortisol also impacts our thyroid. So your thyroid gland makes thyroid hormone, T4, that goes around and around in your bloodstream, but that T4 thyroid hormone doesn’t really do anything. When it gets in your tissues, you have to activate it to T3, and that’s the one that gives you more energy and burns more calories and burns fat, but when cortisol is at a whack, you can’t activate your thyroid hormone into T3.

So even if your thyroid gland is normal, even if your doctor measured your thyroid test and told you it was normal, if you can’t activate and use the thyroid hormones, then you’re gonna have all the symptoms of hypothyroidism and how frustrating is it when your doctor tells you everything is fine. So one of the many, there’s several causes for why you might not use your thyroid hormone, but one of the really common ones is a cortisol problem. So this was part of what was going on for me. I was hypothyroid, I knew that. I was on thyroid medication. By the time I learned about all this, I’d already been on my thyroid medication for 10 years. I still had all the symptoms of low thyroid, but because my lab test was normal, my doctor thought I was normal and I thought I was normal because that’s what we were trained, so I just thought I was a cold-natured person who needed way more sleep than everybody else, but because my adrenals were outta whack, I couldn’t use that thyroid pill, the thyroid hormone in that pill that they were giving me. 

I was on SYNTHROID, which is the standard one, and so I still had all the symptoms, and it wasn’t until I could get this whole system back to normal again that I got to feeling better. So adrenal function is so, so important for thyroid function. And sometimes the opposite is true. Sometimes I see women who are sure that it has to be their thyroid. They’ve got all the symptoms of low thyroid. They’ve had it tested so many times and it always comes back normal. And sometimes it really isn’t the thyroid, it’s the adrenals because there’s a lot of overlap between thyroid symptoms and cortisol symptoms. So adrenal function affects our female hormones, affects our thyroid hormones, but it also is really important for testosterone, and we think of that as the male hormone, and of course, stress and cortisol problems are a really important cause of low testosterone in men. Cortisol kind of shuts down testosterone production, but it’s true for women, too. For women, testosterone is our get up and go hormone, it’s our motivation, our self-esteem, our confidence, decisiveness, competitive drive, and so when cortisol goes down, we just feel kind of flat, unmotivated. 

We kind of make our way through our life, and if something has to happen today, we’ll make it happen, but if it doesn’t really have to happen today, we kind of just leave it by the side ’cause we’re not really feeling it. We tend to procrastinate. And when cortisol goes up, it impacts another hormone from our adrenal gland called DHEA, and DHEA is the one that our body can use to make testosterone. So when we’re stressed, all the resources go into trying to squeeze out enough cortisol to make it through the day, and that’s at the expense of the DHEA, which goes down, and therefore our testosterone goes down. And so now we don’t feel great, we’re unmotivated, sex drive goes right out the window, it affects our muscle mass. We just get saggy and we get the saggy skin. Our skin ages at an accelerated rate, and we just don’t feel as good as we could. And then one more hormone I’m gonna tell you about before I stop and give you a break-

Dr. Sharon Stills

I love it!

Deb Matthew, MD

It’s insulin, so insulin is the one that regulates our blood sugar, and cortisol problems cause insulin problems. So now it kind of pushes us towards becoming more like pre-diabetic, and even women who don’t have standard risk factors for diabetes, they’re not eating the wrong foods, maybe they’re not particularly overweight, but if they’re stressed, it impacts our blood sugar in two different ways: high cortisol causes more insulin resistance, which means our insulin level goes up, and insulin is the fat-storing hormone, so then it makes us gain more weight. So the cortisol makes us gain weight, and then on top of it, the insulin makes us gain more weight and they both put it right around your bowel. But the other thing that happens is cortisol’s other job is it helps to hold up your blood sugar in between meals, so if you’re running low on cortisol, then your blood sugar is gonna start to go downhill in between meals, and that’s when you start to feel hypoglycemic. 

So you can feel shaky and weak and tired, but a really common way that women complain of feeling, and men, is just brain fog, like, we can’t think straight, we can’t really focus, we’re crabby, we’re grouchy, and we’re just gonna stab you in the back if you stand between us in the fridge ’cause we gotta eat something right now, but this drop in blood sugar can be a sign of low cortisol. So if you feel that way, like, you just don’t feel your best and then you eat something and you feel so much better, that could be a sign of low cortisol. And I talk to women a lot who tell me they keep protein bars in their purse, they got nuts in the door of their desk, they’re kind of snacking all day long because they know they need to keep fueling themselves in order to feel okay, and you shouldn’t have to do that. So you may have learned how to kinda self-medicate this a little bit, but it’s still a sign that something’s wrong.

Dr. Sharon Stills

I was the queen of that when my adrenals were shot, I would always have a hard boiled egg or a turkey slice or a little bag of nuts, and I was, as you say, self-medicating with protein just to stop the ups and downs and the hangry feeling.

Deb Matthew, MD

Yeah, oh that hangry.

Dr. Sharon Stills

So that was wonderful. I hope everyone who’s listening really took that in, and even if it was, you didn’t get it all, you could listen again, but just showing the interactions and how it is so interwoven, and for example, and you brought up a few really important things I just wanna go back and reflect on, when you were talking about your own story and being on thyroid, and so often, either someone just wants to keep, “Well, let’s just raise your thyroid, raise your thyroid,” and if you’re on something and you keep raising it and your symptoms aren’t going away, you’re probably not getting at the root issue of what’s going on. And then the flip side of that also is if your doctor, if you’re the poster child and have, say, all the hypothyroid symptoms, and your doctor’s like, “No, your labs look fine,” and they’re not paying attention to you because, I always pay attention to the patient first and foremost, and if the labs match, it’s like, “Woo-hoo, the labs are matching. We’re like got a home run here,” but if the labs don’t match, labs are just a guideline, and so the ranges that they give you, there are often optimal ranges that are different than the lab ranges, and even if you’re inside those and you’re still not feeling good, it’s important to find someone, a doctor who will work with you and listen to you, and keep digging and digging. And the thyroid’s such an important one. It is so integral with the adrenals. I won’t even start anyone on thyroid until I’ve addressed their adrenals because if you just pump the thyroid and you haven’t paid attention to the adrenals, you’re just gonna make the adrenals worse and worse and worse. And so thank you for doing that little mini masterclass on all the different intricacies.

Deb Matthew, MD

That’s right.

Dr. Sharon Stills

So-

Deb Matthew, MD

Well it does, it sounds complicated, and of course it’s complicated, but the good news is that there are lots of things that we can do to make it better. So at least let me say that.

Dr. Sharon Stills

Yeah, let’s talk about them. So what can you tell our lovely ladies listening? What are some lifestyle things? So they kind of have an idea now of, “Okay, this is an issue, I should get it explored. This is the way I should get it explored,” but what are things they can start doing on their own?

Deb Matthew, MD

The good news is for adrenal function, there is a lot that we can be doing on our own. And in fact, there is no medicine for this. So it’s not like you can March into your doctor and they’ll give you some pill. We don’t have any medicine for it, and that’s precisely why your doctor isn’t testing for it or doesn’t know what to do with it because there’s no prescription medicine for it. But the first step would be to do our best to deal with stress. So if we can reduce stress, that’s nice, ’cause to be really honest, sometimes we do it to ourselves. I am the master at overscheduling. That is my superpower. I create a lot of my own stress. I know I’m not the only one that does this, but sometimes there are things that we can sort of sit back and look at, and we can make some different choices in order to reduce our stress, that’s great. The problem is a lot of times there are stresses that are not going away, so we can’t reduce everything. And some really important things to know is it’s really not about how much stress you have, and so much more is how you allow the stress to affect you. 

So if you are somebody who is a worrier and you’re always jumping to the worst-case possibility, and that’s where your mind goes, or you ruminate over and over again about that conversation yesterday, like, “I can’t believe she said that to me,” if you get stuck in these negative thoughts, you take whatever that stressful situation is and you just make it so much worse. If you can be more of an optimist, if you can let it go, if you can think about positive things, you can still have the exact same amount of stress, but it really goes a long way to protecting you from the negative effects of the stress on your body, and you’ll feel a lot better. It’s a simple thing to say, but of course it’s hard to do. You have to recognize in the moment that you’re thinking these things, but if you can learn to recognize it and learn to change your thought, it’s really powerful medicine. And sometimes what can help is if you physically say out loud, “Stop,” or even put your hand up, “Stop,” or clap your hand, some kind of a physical thing just to break that thought process, and then you can turn your thoughts to something more positive. 

So positive thinking is powerful medicine, prayer, laughter, all in the same kind of category of positive medicine, literally changes the chemistry in your body, lowers your cortisol, reduces inflammation, and starts to make these hormones better. Another way that we can harness this kind of positive energy is gratitude. So having a gratitude journal, I love my gratitude journal. Every day, I write down at least three things that I’m grateful for, and some days I just fill up the whole page and think of as many things as I can. Your body can’t feel stressed and overwhelmed and angry and bitter and fearful, and grateful at the same time. So again, when you are, even no matter how bad it is, you can always find something to be grateful for. And so thinking about the things that you’re grateful for, thinking of three things that you’re grateful for is a really great stress reducer. Outside of the things that you’re thinking, other things that can be really important are physical things that you can do, so yoga, walking, Tai Chi, even just stretching. 

If you think about it, when we are in danger, we tend to curl in the fetal position, and when we’re talking about stress, your brain is recognizing that you’re stressed and then it’s sending messages to your body, but your brain is getting messages from your body, too. So all day long, if we’re at our computer, here’s another thing that I do right? At the computer, we get all hunched over like this, it’s kind of like we’re going into the fetal position and your brain is sensing that there’s danger. It doesn’t know the difference between a computer and a saber tooth tiger chasing you. So your brain will start to make more cortisol. Whereas if you can stretch open this way, you’re exposing your vulnerable belly and your throat, that’s giving your brain the message, “It’s safe.” Just like when your dog feels safe and rolls over and gives you his belly to rub, right? Stretching this way helps your body to know things are safe and can help lower cortisol levels.

Dr. Sharon Stills

I think we should take a break.

Deb Matthew, MD

So simple.

Dr. Sharon Stills

Everyone needs to do that right now. So everyone who’s listening, just…

Deb Matthew, MD

Yeah, stretch and open. It feels good, doesn’t it? Another one along those lines is deep breathing because when we are in danger, we tend to take rapid, shallow breaths. And so when we are stressed, we also tend to take rapid shallow breaths and our brain senses that there must be some danger around here and starts making more cortisol, but if we can do deep, slow breathing, that tells our brain everything is okay and we can lower our cortisol level. And I gotta tell you, I’m a very concrete person. I like sort of facts and logic. So here’s how I understand this. 

Our diaphragm is a flat muscle that slices us in half. It goes under our lungs and it goes up and down and pulls the air in and out of our lungs. And we have this vagus nerve, which, it’s this great big nerve, and it attaches our diaphragm all the way up to our brain. So if you start doing these nice, deep breaths, it’s literally yanking on your vagus nerve, which is telling your brain to calm down. It elicits the relaxation response, cortisol levels can normalize and things can get back to normal. So so far, these are all simple things, right? We haven’t talked about losing 20 pounds or cutting all the sugar out of your diet, or never drinking alcohol again, these things are simple things. The thing that I find really challenging for a lot of women is they’re not things that are valued in our society. What we value is work, work, work, and multitask, and bring home the bacon and do everything and be everything for everybody else, and especially for women, right? We’re caretakers, we wanna do for others, we put ourselves last, but these are simple things that are really, really important, powerful medicine, and I would really encourage them for all of us. At least find one or two things that you can just put in your regular routine because it’s the regular routine of it that really makes a big difference.

Dr. Sharon Stills

I love that, and I love that you brought that up because that’s such an important… I’m a rehabilitated adrenal destroyer, and I can remember years ago in my ’20s, where I thought I needed a medal and I should be patted on the back because I could stay up till midnight and just sleep till four, and I could just work, work, work, and do whatever I needed to do, and I only had to be asleep for four hours, and that was fine and dandy for a few years while I was in my ’20s, but then you rob Peter to pay Paul and you start paying for it in your ’30s, and so if you have younger children or relatives, it’s a good conversation to have with them because you might be able to get away with it then, and now, my body, 30 years later, lets me know. If I push it and stay up a little too late, it’s gonna be a little bit of getting back on track, and so it’s kind of this way of keeping me on the healthy path. And shifting that story to there’s there’s benefit, and there could be metals given for having white space in your day, for not piling it all on, for really being in touch with, is this a hell yes? And if it’s not well, then make it a no. And so thank you for bringing that up. Those are really important, important topics that really, adrenals are such a lifestyle orientated organ. And yes, if you have adrenal dysfunction and your cortisol’s bottomed out, you can take bioidentical cortisol and you can take herbs. Do you have favorite things that you like to use?

Deb Matthew, MD

I do!

Dr. Sharon Stills

I’d love to hear that.

Deb Matthew, MD

I do, so some of my go-tos, well, one would be ashwagandha. So ashwagandha is an herb. It’s from Indian medical traditions, and it helps to reset that circadian rhythm. So it helps to make the right amount of cortisol at the right time of the day. So whether you’re too high or you’re too low, it can still help to kind of normalize that pattern. So I like ashwagandha. Another one that I like is called Relora, and this is from magnolia and it’s very calming. So this one is really nice for people who are just in that fight-or-flight response, and they just feel wired and they’re stressed out all the time and they just can’t feel, feel calm and relaxed. It’s a really good one for that. Another really good one for people who feel stressed all, one of the things are proteins, but L-theanine is another one that is calming, especially if you’ve got a racing mind and you just can’t turn it off, and just can’t let things go, L-theanine is a good one. Another one that I really, really like is magnesium. Magnesium is a natural muscle relaxant, it’s calming, it helps us to sleep better. You need to sleep if you’re adrenals are gonna function properly. It does over 300 different things in the body, and one of the things that it does do is it helps with adrenal function.

Dr. Sharon Stills

Mm, great, great tips. And I love that these are things that people can try safely on their own, and so I love ashwagandha, I love L-theanine. I’m like all of those are in my little medicine cabinet. I also love vitamin C. I think can really be beneficial for the adrenals, and B5 is a really pantothenic acid, it’s another one that can really support adrenals that are safe to try on your own. But I think the best thing to do, if you’re listening, is to really get your adrenals properly evaluated. And so any last words of wisdom before I ask where people can find you?

Deb Matthew, MD

Let me make two different points. So one is for people who are generally healthy, but they’re just, you’re overscheduling, or you’re just stressed, doing all of these things that we’ve just said, breathing and maybe going for a walk and laughing, and taking some ashwagandha, can really help them make a difference and can help you get back to feeling like yourself again. For some people though, there’s a bigger underlying cause for why they have an adrenal problem. It could be a million different things. It could be nutritional deficiencies, it could be digestive problems, inflammatory conditions, toxins in the environment, hidden food sensitivities, there are many, many factors that are physiologic stresses. 

So there’s not just the emotional stresses we know about, but physical stresses going on in our body like exposure to toxins that you didn’t even know you were being exposed to, all of those act as stressors on our system, too, and sometimes we have to deal with those things because no amount of breathing exercises and ashwagandha is gonna fix the problem if you’re full of toxins, or if you’re eating foods that are constantly causing inflammation in your body. And then one more thing is that what happens when we are young impacts our adrenal function. So if you went through traumatic stuff in your childhood, that puts you at greater risk of having problems as you’re getting older, and so give yourself grace, find healing. Sometimes you have to go back and work on the things in the past in order to really get all the way to feeling your best in the future. So sometimes it’s not as simple as breathing exercises, but that’s when you really need to find somebody who can help you. And it’s really important to find somebody who looks at things from a natural approach, a functional-medicine approach because there’s no pill to fix this. You can’t just go to your doctor and get them to write a prescription. It’s just not how it works.

Dr. Sharon Stills

Oh, you’ve read off such good points, and I always, I love when women who are trying to get pregnant come to work with me and they give me enough time because one of the things you made me think of when you talked about how it can happen when you’re younger, and if your mother doesn’t have functioning adrenal glands when she’s pregnant from you, she will start to steal your cortisol that you start producing in the third trimester, and actually you’ll be born hypoadrenic and you’re already getting a start of being at a deficient state. And so it is so important that you take care of yourselves, and that you don’t beat yourself up. The past, what’s happened, we can always go in and repair it, but it is important to look at this longitudinally, and adrenal glands are something you have to kind of just cherish and nurture. I find that, especially someone who’s had severe fatigue, that it’s something you kind of always have to be loving along the way. It takes a long time. You have to give yourself, like you say, grace, because you’re not gonna just take a pill or do a deep breath, and it’s gonna be better overnight. You have to give yourself time and patience, which is part of the healing process of finding that space. And absolutely, all those physical things, it’s so important to look at everything, the whole gestalt. There’s so many, always makes me wonder when patients come in and they’re like, “My doctor said they can’t figure out what’s wrong with me.” And to me, I’m like, “Oh my God, we have like 75 different things to possibly uncover.”

Deb Matthew, MD

I know!

Dr. Sharon Stills

We’ll figure it out, might take a day or two. So thank you so much for being here. What a great education you shared with all of us. And so for those who wanna learn more about you, where can they find you?

Deb Matthew, MD

Well, one thing that I’d like to offer is I’ve written a book about hormones to help women understand if their symptoms could be a hormone problem ’cause that’s part of the thing, right? You don’t feel good, you’re not sure. Is it my adrenals? Is it my thyroid? What is it? So I’ve written a book, it’s got lots of quizzes that you can take in order to see do you have symptoms of adrenal problems, symptoms of thyroid, estrogen, whatever it may be. And it also talks about what can you start doing naturally to feel better and how to talk to your doctor about it so that you can have a conversation, and if your doctor’s not really quite given you what you need, how to find the kind of doctor that can help you. So it’s a really great resource. It’s called, “This is Not Normal: A Busy Woman’s Guide To Symptoms of Hormone Imbalance,” and that’s available to download the free ebook. And my website is signaturewellness.org.

Dr. Sharon Stills

Wonderful, well, we will definitely have that link for the ebook. I can’t wait to download it. So thank you. Thank you so much for being here. This was just fantastic. And I feel like mission accomplished. We covered what we needed to and hopefully now everyone who was listening has a much better understanding of the adrenals and the web of which it’s a part of, and how we get healthy or how we don’t feel good, and some ideas of what you can do, and testing. And so thank you so much for that, and thank you everyone for being here, and we are rocking it. We are mastering the menopause transition. And so now you have some notes you can jot down about the adrenals. I kind of envision each session we have, you can take some notes and by the end, you’re just gonna have this big document of how you can master in points from each. And so this was certainly gonna be one of the foundations for women to guide their way. So thank you so much for being here. Thank you everyone, and we’ll be back with the next one soon. So be well.