Adrenal Fatigue is a Myth with Beth Bundy

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Adrenal Fatigue is a Myth with Beth Bundy

The terminology adrenal fatigue may be the incorrect vernacular to describe what is actually happening at a physiological level. It's far more complex than worn out adrenals.

So what's going on - is cortisol low, or high? It seems that this old Naturopathic axiom may have been born from a misinterpretation of Hans Seyle's work and that it needs adjustment, to bring it back into alignment with current science.

This episode is part one in a two-part discussion with Beth Bundy on why the term adrenal fatigue is incorrect, what is actually happening with our hormones and neurotransmitters and what nutrients and lifestyle interventions to choose for these patients. 

Covered in this episode

[00:44] Welcoming back Beth Bundy
[01:25] Is adrenal fatigue a myth?
[06:27] Revisiting the physiological stages of stress
[19:09] We need a change in vernacular. 
[24:18] Understanding adrenal insufficiency 
[28:53] HPA dysfunction or maladaptation
[31:44] Supportive nutrients & lifestyle factors
[42:00] Supporting neurotransmitters
[44:03] The hormonal interplay
[45:05] Measuring and testing, a topic for a future podcast


Andrew: This is FX Medicine, I'm Andrew Whitfield-Cook.

Joining us on the line today is Beth Bundy. Beth is a qualified naturopath of over 20 years, specialising in integrative and functional medicine. She worked previously as technical consultant with Pathlab, one of Australia's original functional pathology companies, and currently trains health practitioners nationally as clinical consultant at NutriPATH Integrative Pathology Services, where she's in high demand as an engaging, informative speaker. She's a lot of fun. She also works as a functional medicine practitioner in a busy and highly successful integrative medicine practice.

Welcome back to FX Medicine, Beth. How are you going?

Beth: Good morning.

Andrew: Now, we're going to be talking about something very close to my heart, well, below my heart. It's adrenal fatigue. But it's adrenal fatigue is a myth. 

Beth: Indeed. 

Andrew: Here's why. Let's go into this. Where did the concept of adrenal fatigue...

Beth: Let's diss it now.

Andrew: Diss it. Where did the concept of adrenal fatigue begin?

Beth: Well, a darling Hungarian, Hans Selye, came up with this theory about 70 years ago of the ‘general adaptation syndrome,’ or G.A.S, which I'm sure we’ve all suffered. Which is talking about how the body's physiological responses to stress. And he talked about three stages, there was the alarm, resistance, and exhaustion. Whereas in the initial phase the body's reaction is the fight or flight. You know, we're ready for...to run from the tiger or the bear, and this is when our sympathetic nervous system comes online, adrenaline, noradrenaline, and cortisol comes into the picture. 

Then the second stage is where we have a lowering level of stress because we've realised that maybe the tiger is not real. And so we're looking after any damaged tissue, and this is when that parasympathetic nervous system will come back in, and things kind of return to "normal." I'm probably going to use a lot of air quotes today, and...

Andrew: We'll imagine your gip gips.

Beth: Yeah, I know, I so need to come with video and pictures. 

But the “normal” levels. But the blood glucose will still remain high because the cortisol and adrenaline will still be circulating. You know, you might still have increased heart rate, blood pressure, breathing. This is when people, you know, the shallow breathers, they might have palpitations. 

So, they're still on alert, but at a reduced level, and then the "exhaustion," the body, you know, can't fight these stressors anymore. Depletion of energy, and if it's not sorted out, this is when the health issues occur. You know, things like over long term we get hormonal changes, we can get ulcers, hypertension, atherosclerosis, you know, some of these chronic conditions we know.

But what I thought was interesting was that Selye himself had noted that stress, in addition to being itself, was also the cause of itself, and the result of itself. Which, I think that belongs on a t-shirt or a bumper sticker somewhere. But I quite like that.

And another interesting thing I discovered, that there is an American Institute of Stress, of course there is, in Texas, and even they concede, even though they’re, you know, they champion Selye, they're now saying, "Oh, what he had to say wasn't really correct."

Andrew: Well, yeah. See, I don't see it as being necessarily incorrect. Because we're talking about hormonal secretion. But I think the big thing is this fatigue, this fatigue concept. To what organ do we attach it? 

Beth: Yeah. 

Andrew: That's the issue. Like, I just...it's really interesting and I used to believe it. I mean, you know, I used to quote, you know, the adrenal shrivel. Really? So, what happens? 

Beth: Well, yeah…

Andrew: You know, we all assumed that it was all to do with the adrenal gland, forgetting the signals to the adrenal gland.

Beth: Yeah. Well, and the other thing is that in about the year 2000, Dr. James Wilson, a naturopath and chiropractor from the U.S. brought out the book, Adrenal Fatigue: The 21st Century Stress Syndrome. Which as I was relatively new to practice, it kind of became the gospel on treating "adrenal fatigue" because that was a terminology he kind of bought up, this adrenal fatigue business. And I would say most praccies of my era would own this book and live by it. And its general tenets are actually...still hold true.

And the whole list of symptoms, there's the list of symptoms in the book with the fancy pictures. And I reckon you could put every client that comes through your door as saying that they've got these problems. You know, with the, you know, decreased ability to handle stress and getting tired, lack of energy, not relieved by stress, they can't get up in the morning, blah-blah-blah. And I think this really took hold of where...that it was the adrenal gland itself, because he talked about...you know, he has pictures of adrenal glands, suffering and being dragged down by all the stresses in the world.

So, it's more about the stages that we kind of got hung up on, I think. And even when I'm talking to pracies and we're discussing salivary cortisol results, people’ll go, "Oh, so what stage are they in?" And I'm like, "Well, you know, it's not...there's not three boxes that people fit in."

Andrew: How does your treatment change? Does it matter?

Beth: Well, I know. It's just like you're putting labels on people and...

Andrew: Yeah, create a box.

Beth: ...you're putting people into a box. So, I think what we need to probably...if I may, is go a bit about the three stages and try and go, well this is kind of what the assumption's been, but this is more like how it works. 

Like when you say it's not just the adrenals, we have hormones further up the line, and we have a brain, and that's kind of where it all starts. Yeah. So...

Andrew: Well, let's delve in.

Beth: All right. So, yeah. As I said, there's the stage model that talks about the adrenal stress, the adrenal fatigue, the adrenal exhaustion. And the theory is that the initial exposure to whatever the stress is, typically results in elevated cortisol, and then your DHEA will remain constant, or even decrease. Now, the cause of the stress, the vitality and the age of the patient will determine the DHEA levels. But it will be lower than normal because age affects DHEA, we must always remember that.

So the assumption is that the adrenal glands are being assaulted and they've got this excessive and prolonged excretion of cortisol. The adrenal glands can't cope, they get all, you know, overcome, and ultimately this is where the theory of pregnenolone steal comes into play. 

So, you know, the theory about that is that all steroid hormones are derived from pregnenolone, which ultimately comes from cholesterol. And that this elevated cortisol either by acute or chronic stress, this leads to less pregnenolone available to be the precursor to DHEA and other hormones. So, in other words, the need for cortisol "steals" pregnenolone away from the other hormones. All right? So that's where this ‘pregnenolone steal’ came from.

So, while we know that an increase in cortisol is common in early and, say, mid-term stress, the notion that there's this limited pool for all hormones to work from is where it's not right. Okay? Because the transformation from cholesterol to pregnenolone actually occurs in the mitochondria of each respective adrenal cortex cell. And so there's no kind of bucket of pregnenolone where one cell can steal from another. And there's not a mechanism actually facilitating the pregnenolone jumping between the mitochondrias of the different cells of the different areas of the adrenals. So, like you know, moving from the zona...what's it called...reticularis to the fasciculata. They cannot hop on a little magic carpet and pop over there instead. They don't emigrate to a better country, you know?

And I think this is...some of the issue is because, when we see diagrams of steroid pathways, because it's such a complex thing and we can't put that on a piece of paper, they kind of simplify it. And so we don't realise all the different regulations there is of all the different enzymes. Your alphas and your betas and things with really long names, of how they affect, you know, what pregnenolone does. Okay? So we need to...can we just move up from the pregnenolone steal concept, for a start.

So, because really what we do know is that prolonged stress does affect the HPA axis, okay? And so cortisol is often driven higher. But this is caused by ACTH production or adrenocorticotropic hormone. Let's just call it ACTH for ease, and that's activating the HPA axis. And of course then we see in feedback mechanisms, we see an adaptation by the HPA axis. Now, this can be caused by an adaptation to a specific stressor. So, for example, overcoming a fear of speaking publicly on a podcast, or a down regulation of the HPA to prevent damage from excessive cortisol. Or both. You know, it could be both.

So, that's the initial kind of thing that happens. And then we have the next stage, or the "adrenal fatigue:" big air quotes. Where they've got chronic stress, and this is progressing to a more permanent down regulation of cortisol production via the HPA. 

Andrew: Yeah. 

Beth: And this is where sometimes we'll see that…you know, so initially on bloods, you might see an elevated cortisol, but in this second stage where things have kind of been down, you know, quietened down, the cortisols will probably be in normal ranges. So you'll say to a patient, "Oh, you're fine." But this is where you also may see DHEA starting to get lower, and you may see changes in the cortisol rhythm through the day. Because we know that cortisol has a diurnal rhythm yeah? It's up in the morning and it lowers over the day, and then should be very quiet overnight.

So again the assumption here is thought that the ACTH stays high and maybe even increase. The adrenals, again, are not responding. Again, pregnenolone steal is thought to contribute to keep that cortisol at a normal level, at the expense of DHEA, and this is why it's called...well, it's adrenal fatigue because you're pushing it all to cortisol. 

However as we had said, there's no evidence, at present, to show that the actual part of the adrenals becomes insensitive to ACTH or even fails to respond to it. It's more likely that the lower cortisols are due to the down regulation of HPA, turning down the ACTH production, which would turn down the cortisol.

Andrew: Yeah. 

Beth: And you've also got to remember people on glucocorticoids. So they're on cortisone, and that's a natural feedback mechanism that will quiet things down as well. And the other thing is we have to remember cortisol-binding globulin. So, this is where you might see high-ish...normal-high cortisol in the blood, but then when you look at your saliva cortisol, it's really low. And this is because we have cortisol-binding globulin that's, you know, hanging onto it all, and it's not bioavailable. 

So again, this is about the body protecting itself from cortisol's damaging effects long term. Just like we have sex hormone binding globulin so we don't have our hormones ranging around all over the place. And we have things like reverse T3 that sometimes will quiet down the thyroid to calm our farm. So remember that this is actually…the down regulation of this HPA axis is a protective mechanism, so we don't all spontaneously combust.

Andrew: Yeah, that’s right. 

Beth: The third stage is that the ACTH levels are now going to be constant, and that's when...this whole exhaustion thing. It's like, "No." The adrenal glands have gone, "No, I'm shutting up shop, I cannot cope with what you're asking me do." But it's just not true. Because now we've got, again, the low levels of DHEA and cortisol is really more about the chronic HPA down-regulation that now then turns into a bit of a metabolic dysfunction as well. And this is when we have more difficulty treating our patients because this has been going on a long time, and like, their sort of, metabolic reserves are all lower and just everything is turned down, so we have to start turning them up, slowly.

Now, what we have to be aware of is using the word adrenal fatigue. Because then people go to doctors and the doctor goes, "What poppycock." But this can be differentiated from true adrenal insufficiency, where, you know, there is problems with ACTH, by measuring ACTH. You know? I think a lot of practitioners just stick with cortisol saliva, and, you know, you really have to look at the blood cortisol and ACTH to have a look if there's a real problem.

Andrew: That's a very good point.

Beth: Absolutely.

Andrew: Prove your hypothesis.

Beth: Absolutely. And we have actually found...we’ve been a little bit more diligent in doing ACTH on patients in clinics. And I'd say we've found...in as many as three years, we've actually found three patients with Addison's, with true adrenal...

Andrew: Wow.

Beth: Yeah. By measuring ACTH and finding it's low. Measuring it again just to make sure there wasn't a wobbly, yes. Sending them off for a…there's a test called a short Synacthen test, where they inject them with cortisol. Or is it ACTH? It must be cortisol. And then they measure their cortisol response. So we've found three Addisonial patients with that. 

Whereas if we had just kept them on… Very different ages too, I must say. And if we had just kept measuring through salivary cortisol, they would have kept coming back saying I still feel like, you know, rubbish. You know, your herbs aren't working. And no they're not because these people need hydrocortisone therapy, for life.

So, really this needs to be… If you're not getting anywhere with someone, I would definitely say to consider ACTH and cortisol in the blood and refer them on to a medical doctor for specialist endocrinology treatment if need be.

Andrew: I haven't looked it up yet, but I was thinking that test would probably be ACTH, wouldn't it? Because if you gave them cortisol, you're really looking at the end target organ secretion, rather than what would control that secretion. 

Beth: Yeah, and I haven't looked that up. 

Andrew: So, I'll look that up. 

Beth: Yeah, look that up, please. 

Andrew: I'll look that up, and I'll post the results on the FX Medicine website for our listeners.

Beth: Yeah. Because I know we just look at the...I just send them up for the test, then we look at the results and I just look at the numbers. I would have to have a look at what they're looking at. 

But yeah, that's been really worthwhile. Because as I say, you can't just put someone in a box and say, "Oh, you're adrenaline fatigued," when they're also a shift worker, they've got diabetes, and you know, perhaps some autoimmune condition as well. So, they don't just fit into that adrenal box, there's a whole lot of other things going. And the most important thing is, don't just rely on a test result. You know, you've got to take your diagnostic and your history-taking into the thing, plus your lab findings. It's the whole picture.

You know, when I have pracies say to me, "Oh, look at this result. What does it mean?" I'll say, "Well, can you tell me something a bit more about the patient?" Because you can't just go off the...

Andrew: Piece of paper.

Beth: ...piece of paper with a number on it, you know?

Andrew: Robotic diagnosis.

Beth: Yes, it's just not like that. So, always have to take their story in.

Andrew: I think, you know, I've got to give kudos to two great doctors, and that's Dr. Andrew Heyman and Dr. David Haase, who really, like, you know, shook the ground. They really woke a lot of people up. Me included, when they sort of said, you know...And I remember Andrew Heyman asking a question and just saying, you know, "Adrenal fatigue. Really?" And he said, "Prove it." 

So, it was a very interesting learning experience for me. And there's a great paper that really explains this well. It's Bruce McEwen, "Protective and Damaging Effects of Stress Mediators," published in New England Journal of Medicine in 2008. And it will poignantly explain why we have the wrong vernacular. It's not the wrong treatment, it's just the wrong vernacular. Get rid of the word "adrenal" out of fatigue.

Beth: And fatigue.

Andrew: Yeah. Just call it fatigue. It’s… They're fatigued.

Beth: They're just fatigued, yeah.

Andrew: Don't try and blame a certain gland because you're looking at the wrong gland and it might misdirect your treatment.

Andrew Heyman...forgive me. David Haase has some beautiful, I think it's PET scanning images? Showing brain volume changes. You know, and Andrew Heyman speaks about this, about the hippocampal changes and the prefrontal cortex changes, things like that. 

I just think it's really interesting how we get suckered into a nice, simple, you know, ‘rolls off the tongue’ concept. And the fact of the matter is, the body doesn't roll off the tongue. The body is really quite complex.

Beth: No, it doesn't roll off the tongue.

Andrew: I should stop there, shouldn't I?

Beth: I think you should stop there. Then we'll get an R rating.

Andrew: So about these changes, you know...

Beth: So we need to change the vernacular, yeah. Because interestingly, the term "adrenal fatigue" is virtually absent from any peer reviewed literature. And the endocrine society is so up in arms about this that they've even put out public warnings against the diagnostic myths of adrenal fatigue.

Andrew: Yeah. 

Beth: And suggest you should cast suspicion upon clinicians using such terms. And I'll actually give you the link to what they sent out, so that you guys can add it to the show notes.

And there's been some...it wasn't a meta-analysis...what's the other one...a systemic review.

Andrew: Right. 

Beth: Also saying that there is no hard evidence for the existence and there is no actual medical condition called adrenal fatigue, so it is still a myth. And even endocrinologists believe that under stress your adrenals work harder and make more cortisol, not less. So...

Andrew: Well, this is…look, this is something I remember asking at a seminar. You know, the literature is awash with high cortisol causing metabolic issues. And even when I hear the term flattened cortisol response, it does not necessarily mean low. You can have flattened and high. It just means there's no drop.

Beth: Yes, that's right. There's just no rhythm, there's no ebb and flow to it. Yes, exactly.

Andrew: You know, and as I remember learning this, we speak about, you know, the general adaptation syndrome, and you get...what's it called...Allostasis and then adaptation with chronic or repeated stressors. And that is basically what that leaves you with, is your allostatic load. I'm trying to in my mind picture this diagram. And I'm pretty sure it's in that Bruce McEwen paper

But the interesting thing that got me was the graphs whereby normally under a repeated same stressor, we get a learned response. We learn that it's not going to kill us, so we go, yeah, another electricity bill, I get it. You know? People in business will say, yeah, another BAS statement, okay. You know, that sort of thing. It's like, yeah, whatever. Whereas the first one used to freak them out. So we learn to live with the stressor, we learn to live with the lion. But what happens...

Beth: Well, because we've turned down, we've turned down our reactance button.

Andrew: That's right, we've coped. But what happens with the maladaptive syndrome is that the peaks keep going.

Beth. Yes. 

Andrew: They keep having this stress response.

Beth. Yeah. 

Andrew: An anxious response to the same stressor day in, day out. That's what really interested me. 

Beth: Well, because it's the meerkat response

Andrew: Yeah.

Beth: Yeah, it's the meerkat. Your little amygdala, you know, keeps firing off. So, you forget that there's no real tiger behind the BAS statement or what have you. And so they overreact, kind of thing, and so...

Andrew: Yeah, and in so many ways. It's not just a feeling of stress. Your gut reacts, your immune reacts, your thyroid can react. So, we're talking about a reaction from your adrenal, your thyroid, your immune system, whatever, but it's not the cause.

Beth: Yes, that's it. So this is where we need...you know, when we talk about the vernacular, we need to just kind of remind people that adrenal insufficiency is true deficient production of, or action, of your glucocorticoids. So of your cortisol, or your aldosterone, yeah? And this has serious life-threatening consequences. This is not like, "Oh, I'm really fatigued and I can't go to work or get out of bed," but...

Andrew: They drop.

Beth: Yeah. And really now I'm seeing these patients, you go, "My god." But one lady, 75 before we discovered her. So...

Andrew: Oh my goodness.

Beth: And she's...I'll tell you what, you'd blow her over and, you know...you could blow on her and she'd fall over because she's a wisp of a woman. And she has terrible problems. You know, she's so osteoporotic now and she's got all these other problems because it was not met, you know, or not discovered way earlier, you know. So, poor darling. Anyway...

Andrew: Look, I remember a friend, a sort of friendly acquaintance many years ago, and she was under so much stress, and we just thought it was stress. And I went, "Tracy, look, there's something else here." You know, her muscle wasting, there was just...there was no...She stopped having her periods, there was no form to her skeletal mass if you like. She was really wasting away.

Beth: And did her colour change? There are colour changes too.

Andrew: Yeah. You know, and she would just drop. But she was under this chronic stressor from an employer. And I said, "You've got to get out, that's number one." I said, "You've got to go see somebody." And sure enough I think she was diagnosed as Cushing's…as Addison's. Forgive me. Addison's.

Beth: Addison's. Yeah, Addison's. Now it is rare. So, they're not going to come through your door all the time. It's just that we do a lot of fatigued people, so we have come across three in three years, right? Because that's probably not what general practitioners...I mean, doctors may, but certainly not other allied health will come across.

Andrew: Oh they’d pick it up, yeah.  

Beth: So, you could say, Beth, remember that primary adrenal insufficiency is Addison's disease, right?

Andrew: Yeah.

Beth: Then we have secondary adrenal insufficiency. So, the primary adrenal is when, yes, the adrenals are not working. Right? They're not listening to the message. 

Secondary adrenal insufficiency relates to where the ACTH either is not coming down the pathway, or that the adrenals are not responding to that. So again, that's a true medical condition. And that's where that ACTH, the short Synacthen test will kind of pick up.

Andrew: And it's measured.

Beth: Then you have...

Andrew: That's the thing, it's measured. You can measure ACTH.

Beth: That's it, exactly. Then the tertiary adrenal insufficiency is when further up the tree your CRH or your corticotropin-releasing hormone is...

Andrew: Not being stimulated, to stimulate the release of ACTH.

Beth: Yeah, and that's...you get the CRH suppression. And so it's...you know, further up the tree it's primary, secondary, tertiary. And any of those true adrenal insufficiencies will need hormone replacement, okay? Because they're not working.

Then there's also the hypocortisolism, so hypo-cortisol, and that could be morning or daily, where the cortisol will be well below the reference range, but this still doesn't indicate fatigue of the adrenal gland. 

Andrew: No.

Beth: But you might see this in post-traumatic stress, chronic fatigue, fibromyalgia, you know, chronic stress and, like, people have got really long, long stressors…

Andrew: Yeah. 

Beth: Certain depressive or effective conditions. Again, this is likely an adaptive response to previous high cortisol production by the hippocampus, hypothalamus, pituitary, what have you, to protect the tissue. 

So, you know...because imagine with post-traumatic stress, if there were stressors, they were, you know, on alert for whatever reason, so then they get down regulated. Yeah? So then their cortisol is just that...like you say, they’re coping. Well, it's a false sense of coping because it's just that everything's been turned down and they're not working.

So, really, you know, with all we've talked about with the HPA, it's probably a more appropriate term we should be using, is HPA axis dysfunction or maladaptation. 

Andrew: Yeah. 

Beth: Because, you know, it's from the brain to the adrenals, it's the whole trip down that evolves. So somewhere in there it's more a maladaptation.

And I'll tell you what, you've mentioned a couple of papers. This is not a paper, this is an actual book but I would like to mention it to everyone because I'm a new fangirl of this fellow.

Andrew: Yeah. 

Beth: Who...it's Thomas Guilliams. He's a PhD, so he's a Dr. Guilliams. And he's had a book called "The Role of Stress and the HPA Axis in Chronic Disease Management." Again, I'll give you the details so you can add it to the show notes. 

Andrew: Great. 

Beth: But it is for the nerds who like to read lots. It goes right into the depths of all of these different things. You've got fabulous little graphical pictures to show you how it all works, and you look at this and you go, "Oh yeah, that makes so much sense," and I love it.

Andrew: Anybody who wants to investigate this will have these, "Oh, yeah," moments. Like, "How was I ever suckered into that term?" You know? 

Beth: Yes. 

Andrew: It's really interesting, you know, when you talk about the immune response that happens later. People under chronic stress, they have, as you spoke about, the coping mechanisms or the coping phase, and then the maladaptive phase, where their immune system starts to trigger and this is where you see more things like I've been stressed for years and I've now got chronic allergies or I've now developed an autoimmune disease or something like that. You know, they might have been primed at birth, but they weren't triggered then.

Beth: Exactly. And that's why people seem to...I think they go, "Well, how did I get this?" Well, it's not just all because of one thing. I mean, look, I know there are things you can say, yes, you've got anaemia because you've got no iron. 

But generally when we have these chronic conditions or these nondescript conditions, they are a jigsaw puzzle of things, they're not a thing entirety. So, I cannot say, how did this happen? I don't actually know because I don't know all the things that have gone in to make you, and I don't know all of your...how you reacted as a child to something versus someone else, what you're predisposed to, blah-blah-blah. 

But the Guilliams book, it's only a little book, but, yeah, I've actually moved James Wilson out of the way to pop this book on...in pride of place in my book case.

Andrew: Yeah, the big thing is the vernacular. I really do think… You know, and indeed thereby we should be looking at perhaps tailoring, I wouldn't say the word change, but tailoring our treatment strategies to involve more brain-supporting nutrients and strategies. Because that’s where you get…

Beth: Well, yeah, that’s the point, because we don't need to change. It's just that we don't have to say, "Oh, you're adrenally fatigued, you take Withania. You are adrenally stressed, you take something, you know, Valerian."

Andrew: Ginsengs. Valerian. So, I mean, this is the classic thing. What does American ginseng work on? You know, what...we talk about...

Beth: Well, it works up higher the tree, that's for sure.

Andrew: Yeah, it works in the brain. 

Beth: Yeah. 

Andrew: What does phosphatidylserine do?

Beth: Oh, phosphatidylserine. I love it.

Andrew: You know?

Beth: It is one of our...it's not, but...the top-selling product we have in clinics. It's great. And it actually works up at the ACTH, you know, and CRH level. 

Andrew: Yeah yeah. 

Beth: So, it's fabulous. I say to patients, you know, especially if they're highly anxious and cortisol-driven, I will say, you know, when you feel like an 11 out of 10, then phosphatidyl can bring you down to a 7 or 8 out of 10 so you can go, "Okay, I'm a little bit more managed now and now I can," you know, “cope a bit better.” 

So, I don't think we need to change our therapies, it's just...because ultimately, just like emergency vehicles need to use the same roads for non-emergency functions, do you know I mean? We're all using the same channels, it's just some things are busier than others sometimes.

Andrew: Yeah, yeah. 

Beth: So, we can still use the same... But the bigger thing I would say is not necessarily about having to, you know, again, give people something. How about just sleep? Sleep is the most important thing you can do for your HPA axis. A proper sleep. 

Like there's, you know, studies that show only two late nights, or two nights with a shortened sleep will increase your cortisol. 

Andrew: Yeah. 

Beth: Only two nights. How many people have restless nights? You know? You need to expose yourself to daylight. You know, we can't go from...

Andrew: Nature.

Beth: Yeah, you need to be out there in the sun because that is where… We're a circadian rhythm kind of animal, so we need light and dark, and we need to go to sleep in a dark room and then wake up to the sunlight. 

You know, like even I’ve sometimes, especially in winter, I get up in the dark, jump in my car, drive to work into an underground car park, stay in a room that has no windows, I do not have windows in my clinic room. Leave at night in an underground car park, and drive home in the dark. 

So, you know, there's days in winter that I don't see the sunlight. And that's why I'm probably a bit cranky in the winter, just quietly.

Andrew: Mental note.

Beth: Mental note, don't talk to me in winter. She's much a summery girl. Yeah. But, you know, how many people are doing that and they're not getting the sun? And, you know, they're staying on their smartphones, head down, and bum up, sort of thing.

Exercise is awesome. You know, we got to get people moving. And like, "I'm too tired to exercise." Oh, for god's sake, you can go and have a walk. 

Andrew: Yeah. 

Beth: You know? Actually low-intensity exercise lowers cortisol level.

Andrew: That raised a little concept in my brain here. And that is about our stress and how stress begets stress. 

Beth: Yes. 

Andrew: You know, that beautiful saying that you said earlier on, we've got to put that one up on the website too. I reckon that's great.

But one thing that Lise Alschuler has taught me, is to be cognisant of the concept of gratitude, and how that amazingly quickly changes your feelings of anxiety, of that egocentricity, if you like. The feeling of gratitude. 

Now, how do you give somebody that? How do you teach them to experience gratitude? That is a big key. Particularly for somebody who's down in the dumps, you know?

Beth: Yeah, absolutely. And I guess that's the thing, is if you give them, you know, little things like saying, well, let's talk about your sleep. Let's get you a little bit of walking exercise. Let's get you breathing better.

Andrew: Ahh, yes. 

Beth: I mean, you had a lovely podcast with our lovely Mim Beim when she talked about Buteyko breathing.

So breathing is important. Because remember how we said when you're in that stress response, your breathing, you know, if your heart's thumping, you're breathing really quickly to expand energy to run away from something. So then a lot of us get stuck in this shallow breathing, we don't get this true breathing which is actually calming, it's that heart rate...what do they call it? Heart rate variability…

Andrew: Heart rate variability, yeah. 

Beth: Yeah. So I think probably teaching people... I've had people sit in my office and I haven't done the Buteyko training, but I've had people just sit in my office and I've taught them how to breath into their belly. Just...You know, because I say, "See how you breathe," and you know, their little shoulders go up and down, and I'm like, "No, no, no. Shoulders shouldn't move. I want to see your belly expand. And I've spent like 10 minutes showing someone how to breathe to fill their lungs and consciously breathe, sort of thing.

So, I can have them calmed in my chair there just by breathing and concentrating on a breath. Which because therefore that's a little bit of heart rate variability, just things like that. That triggers...and it's probably all little proprioceptors that I can't name at this present time. But that's triggering things back to the brain to go, "Shh, it's okay. The tiger is gone." 

Andrew: Really interesting stuff, isn't it?

Beth: Yeah, yeah, yeah. 

And the other thing we have to get people to...so this is before we even given them any supplement...is to how about eating properly too? You know? Carb, carb, carb, which is… this is what I find, my cortisol, my really fatigued people, will go for the quick fix and they'll go for the sugar high, or caffeine high. And what we have to remember is hypoglycemia is a trigger for cortisol release. 

Andrew: Yeah. 

Beth: So, if you're bouncing around with your sugar up and down, up and down, your cortisol’s bouncing around as well, which will elevate your blood sugar and then the number of people that come in and say, "I'm fat, I want to lose weight. Fix me." It's like, "Oh, babe, we have to go back and we have to calm your farm before we can get rid of your fat." You know? 

Andrew: Yep. 

Beth: Because we're going to put on fat as a protection mechanism because we've got all this cortisol and blood sugar swimming around.

And then we need to do all of that, and talk to them seriously about that, before we bring in our beautiful adaptogenic herbs, and our nervines, and our vitamins. And vitamin C is important, and B complex is important. Phosphatidyl should be a staple for some of these people. 

And of course then you have to assess these people and treat them… Inflammation. Where is inflammation coming from? Have they got insulin resistance? You know? It's not just a supplement.

Andrew: I think it's interesting to note though, you know, like, if you give a B vitamin supplement, a complex, to somebody that's in the first stage of adaptation where they're really pretty much coping. They might be feeling the stress, but it's not like a wave over their head. They're feeling stressed, but they're okay, they're not liking it. The response that you'll get from giving them a B supplement, or even a multivitamin, is different from somebody who's way down the line, they've been battered down, they're hammered, flat. And these people actually respond so much better to things like phosphatidylserine, the B5, B6, B complex, you know, magnesium, all of these great minerals, the adaptogens, the nervines. 

So, they respond much better indeed to a point where sometimes you can get somebody who's quite sensitive to these, and you've got to be a little bit cautious in how you give these, particularly when they've got the immune issues and stuff like that. I think it's really interesting.

Beth: Yeah, you just can't go in all guns blazing. And interestingly, what you say about the coping. I find that, you know, a lot of people… You know, I love when people sit in my chair opposite me and they're talking about that and we talk about stress and they'll say...you know, and they've just told me that their business went under, they were bankrupted, they got divorced, they're still in court with their husband, you know, there's all these...their mum just died, blah-blah.. And they tell me that, "Oh, but I'm not stressed." And I'm like...I just go, "Really? Then what are you sitting in my chair for? Get out and let me have someone who's really got a problem." I just go, "Oh my..." You know, it becomes...

Andrew: No, they're stressed.

Beth: Of course they're stressed. It's just that their reaction and how they are has become their "normal" because it's this down regulation. They think they're coping and that they're okay. It's just become their normal. So, but it doesn't mean it's “normal.” Do you know what I mean? It might be common for them, but it's not normal. You know? 

And this is where I have to explain to them. It's like, well, you've come this way, you've got to this point. You know, they'll say, "Oh yeah, but you know, the business thing or the divorce thing or the death thing was five years ago." Okay, yeah, but what's happened...you know, if you're 45, what's happened in the last 40 years? It's not just about what happened five years ago.

Andrew: Yeah. Do you ever employ the amino acids, you know, like GABA, which is...Like, I'm not convinced that it does cross the blood-brain barrier as GABA, but it certainly seems to work in the gut from the research I've read. 

But how… Like, I've spoken to people, indeed some people that use it in a veterinary sense.

Beth: Oh?

Andrew: Yeah, with really good effect. I think it's really interesting how it works, but I'm wondering how often do you employ things like GABA and L-theanine.

Beth: I definitely...I love L-theanine. I do use GABA, you know, not as a stalwart, but I have used it when I really need to… You know, I love Kava. 

Andrew: Oh yes. 

Beth: Yeah, I love Kava. Especially for those people that are pinging, to again, help turn them down and bring them from an 11 out of 10, down to a 7 or an 8. 

Andrew: Yep. 

Beth: I do find that things like the kava, the GABA, the...what was the other thing I said? L-theanine. I do use 5-HTP too sometimes on people, because...

Andrew: Ahh, yes. Just be cautious of what else is around there. But it works so well...

Beth: Oh indeed, depending on what they're on and I monitor them closely. 

But there are other things. Because your neurotransmitters definitely play a part of this. You know, again, we're stuck on the adrenals, and now we've been talking about, "Well, the message comes from the brain," but so do neurotransmitters.

Andrew: Feedback.

Beth: And melatonin is a neurotransmitter, and you make that from serotonin. So, you know, your cortisol might be low, but if your melatonin is as well, then you're not going to get a quality, restful, restorative sleep. 

So, you know, this is where, you know, some of the medical practitioners can instigate prescribing melatonin, or they might even use pregnenolone and DHEA. 

Because one of the other things from progesterone...so this is especially important, right, when we're dealing with our ladies too. 

But progesterone, one of its metabolites is allopregnanolone, right? Which is a precursor for GABA, yeah?

Andrew: Right.

Beth: So, sometimes when our ladies are really stressed out and pinging out, you also have to deal with their hormones and up-regulate their progesterone so they can make the allopregnanolone, which is...you know, this is what calms our ladies. 

Andrew: Got you. 

Beth: This is why our PMS ladies are a little bit, you know, let's just say not quite right. 

Andrew: Wired.

Beth: That's why men have sheds. We know that. 

But some of that will be the allopregnanolone. And so, again, sometimes when we treat these ladies with oral progesterone, that helps up-regulate their allopregnanolone which then helps up-regulate their GABA, and they can be, you know, a bit more relaxed and calmer.

Andrew: In wrapping up, we need to measure the right things, don't just think that it's all in the adrenals. Measure things that the adrenals affect and are affected by other glands. Make sure of what condition you're dealing with because there may be an underlying, undiagnosed condition that really requires medical attention and pharmacological intervention. 

Help people cope from an emotional level and their stressor level. We know that we can't get...you know, solve everybody's problems, but we can certainly intervene to try and, you know, see if they can look at things a different way and maybe have a better coping mechanism. And I think that's a real key for the 21st century. 

Eating right, sleeping right, and where appropriate, intervene with some judicial supplements.

Beth: Yeah, I think it's about, you know, really having an education of the patient, but we do not have a pill for an ill. We do not have it. 

But usually when patients say to me, "Well is this there just something I can take?" I say, "Yeah, you can pop down the local health store, I'm they've got some tablets that will give you a bit of an upper." But that's...

Andrew: That's not health.

Beth: That's not healthy, and it's not helpful. Whereas if we can educate them, "Well, you took quite a while to get to this state, it's going to take us a little while to get you out of this state, and these are all the things you need to do to help assist. Because those are all the things that you weren't doing properly that got you into this mess in the first place." 

So yeah. And then of course there is the testing but, you know, and then that's a whole other...maybe that's a whole other podcast yet again because we've to different ways of testing.

Andrew: Let's get you back and we can talk more about which testing is appropriate when.

Beth: Yeah, all right.

Andrew: Great, Beth.

Beth: Sounds good. 

Andrew: Done.

Beth: Stay tuned everybody.

Andrew: I love your analogies and thank you so much for that quote. We're definitely going to put that up on the FX Medicine website for our listeners. Thank you so much, Beth Bundy, for joining us today.

Beth: Fabulous. Bye everybody.

Andrew: This is FX Medicine, I'm Andrew Whitfield-Cook.

Additional Resources

Beth Bundy
NutriPATH Integrative Pathology Services
Hans Selye
The American Institute of Stress
Book: Adrenal Fatigue: The 21st Centruary Stress Syndrome, by Dr James Wilson
Book: The Role of Stress and the HPA Axis in Chronic Disease Management by Dr Thomas Guilliams

Research explored in this episode

McEwen BS. Protective and Damaging Effects of Stress Mediators. NEJM. Jan 2008: Volume 338:171-179. 


Other podcasts with Beth include:


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FX Medicine Podcast
FX Medicine is at the forefront of ensuring functional and integrative medicine gains the recognition it deserves and ultimately establishes itself as an integral part of standard medical practice. Hosted by Andrew Whitfield-Cook, our podcasts are designed to promote research and evidence-based therapeutic practises, acting as a progressive force for change and improvement in patient health and wellbeing.