Genetics, Epigenetics, and Lifestyle

Welcome to Everyday Wellness podcast. I'm your host, nurse practitioner, Cynthia Thurlow. This podcast is designed to educate, empower and inspire you to achieve your health and wellness goals. My goal and intent is to provide you with the best content and conversations from leaders in the health and wellness industry each week and impact over a million lives Today is a compilation of adrenal centric conversations I've had on the podcast with experts doctors Sona Jensen, Dr. Carri Jones, dor. Scott Sher Dctor Will Bolchowitz, geneticist, Dr. Gle Joffy and nurse practitioner Heather Qule and physicians' assistant McCall McPherson. We dove into the impact of generational silence and how the thrifty genotype impacts susceptibility to poor metabolic health outcomes over time, how our immune system and nervous system are impacted in midlife. Defining the GABA urgic system and the role of decreased progesterone in perimenopause, the impact of GABA cofactors How adrenal health is tied to thyroid health, The role of stress and the impact on ovarian aging, which is huge The role of shift work and disruption in circadian rhythms and how this influences our gut microbiome, and last but not least, the impact of genetics on lifestyle choices and our response to them. This is an action packed, information packed, adrenal centric podcast that I hope you will enjoy listening to as much as I did putting it together So kind of getting back to family and the concept of generational silence and how our mothers, our grandmothother's generation were' expected to suffer in silence. There was just a very different Mindset and philosophy, I recall my maternal grandmother who was an amazing woman haaving conversation with her sister, who was also widowed And I recall I was probably maybe I was twenty, saying, do you think you'll ever get married again? And they both looked at one another and they looked at me and they said We're totally happy, never getting married again. They're probably in their sixties Totally happy, never getting married again. And I remember my grandmother leaving me with this She was never a complainer. And so she just said In my generation, Cynthia, if we got married, we stayed married irrespective of whether or not we had a happy, healthy, fulfilling marriage And your generation has so many more options. And you know, I think that my grandmother now as I understand her My grandfather was a very domineering controlling person mayaybe not physically abusive, definitely emotionally abusive. And so For me when I reflect on that generation of women that subjugated their needs maybe weren't able to speak up who in circumstances, they just worked really hard and raised their kids and did the best that they could. And I'm not suggesting that doesn't happen now too But I do think that If we are exposed to a lot of stress and trauma, It can change us epigenetically. We can pass that along to our offspring. to us about generational trauma as well as silence. And I know, again, I think our generation is speaking up and out about this more and certainly trauma' having a moment But talk to us about how that changes us physiologically. Yeah, I love that question because I think once we start to really understand it, we know oh my like the light bulb goes off the why we're behaving a certain way or our body is a certain way. And so Rachel Yahuda's work is I love looking at all the research that she's doing. And she did some studies on Holocaust sururvivors to give you kind of an extreme example. So when she studied this group of people and looked at their offsprings, to look at their hormonal health, specifically their adrenals. She saw that one hundred percent of those infants were born with adrenal insufficiency So their cortisol awakening response was just not there So you're already then born with this inability to manage stress. So imagine being born with that and then moving through life and all the stressors that show up. throughout our lifetime And if our adrenals are already burnt out Our progesterone is going to be low We're not going to get that support that we need when we need to move through stress So our immune system iss going to be compromised, our metabolic system's going to be compromised. And what they saw on the grandkids is metabolic syndrome So you start to see this trickle effect happening in the generations because of the stories that were held by the past So that doesn't mean that we're to it, but I think it can give us information so we can navigate life a little bit differently. When I looked at my own ancestry and during the colonizing years, when there was lots of famines in India There was about fifty famines in one year And so when you look at that number, you see something's going to change in that individual's physiology. So our beta cells don't function as maybe your beta cells do And so this is why there's more benabolic syndrome, there's more diabetes, more heart disease in our community. And so again, if you can understand those elements, you can make choices in your everyday with your habits, with your food, with your exercise, that can support your physiology So when a woman sits in front of me, I think it's so important to understand her story as a woman. and then there's layers of culture There's layers of where she's from That's so important to understand. So you can actually have that unique picture in mind when you're treating someone or even for yourself when you're You know, I think women wear the hardest on ourselves. You know the mind can play some amazing tricks. and when we look in the mirror, especially first thing in the morning, we don't often think something positive There's often a criticism that's there And so when the body's not functioning, the way it's maybe meant to, quote unquote, the first thing that we do is blame ourselves and not understand that there might be this story playing out in my physiology that I may not have A lot of control over, but I do have control over These choices that I'm making every day. There's so many beautiful things that you said there I think I'm going to start backwards and work forwards So there is a thrifty genotype It's something that a lot of my Southeast Asian colloeagues talk about So you mentioned that famine. I didn't realize at one point fifty famine within a one year time. Is it any surprise? that Epigenetically. Indian lineages and it's not unique to India, but I'm sure it's many becausecause there was a risk of not having food to eat that your bodies became much more efficient at extracting calories probably from food. And then you mentioned the beta cells in the pancreas not working as effectively I think this is why it's so important when we as clinicians are meeting with patients to really be understanding about backgrounds, like not make assumptions because I think it is so critically important because it's one of many components that helps us better understand our patients And then the other piece about the experiences that women go through and Rachel's work in particular, which I find so incredibly Interesting, fascinating, disturbing all at the same time So if someone born with already suppressed adrenal functions. So we're talking about hypothalamus, pituitary, adrenal acis, suppression What does that put them at risk for? Like what are the things that might show up for them as males or females that may show up for them that they're more susceptible towards than someone who doesn't grow up under those circumstances. Th those extreme circumstances. Yeah. Well, the immune system is intimately linked to that. so their inflammatory markers are often higher, especially interraleukein six So that's one thing to watch out for. The other thing would be just your emotional resilience isn't there. So in your everyday life thoseose moments where maybe you shouldn't feel irritable, you're feeling irritable, thoseose moments where anxiety is showing up out of nowhere or the fear of stopping you from taking that adventure or making that choice in your life I think there's so many elements that it'll affect from your relationships to your physical body And when you don't have extra boost of cortisol that we actually need cortisol, I think is said to be the villain a lot but we really do need it to feel motivated. We need it for energy. we need it to like I said, support the immune system in many ways too So for in general, I would say that's what are things to look out for. And then for women Looking at your progesterone, you're looking at your estrogen, you're looking at the impact it's having on your insulin levels as well So if you're born with that adrenal insufficiency, your body is not navigating a hormonal story as well as it could you may be more prone to PCOS. You may be more prone to cysts and fibroids and all these things. So I think it's so important when looking at women's health and their hormones to look at that triad If your adrenals are insufficient, so your thyroid would probably be impacted by that and your ovaries. So looking at all three of them is so important when treating Yeah, absolutely. I mean, this is the first time I've talked about this, but When I was pregnant with my older son I still had a stressful job, but it was a different type of stress After having my first son and I was pregnant with my second, I went and changed to work for a very large cardiology group in Northern Virginia And I worked for someone who was really hard to work for. And when I say really hard to work for She was a very nice person, but she was very difficult. We did not We had a challenging relationship. We were not from the same gener generation, and she expected me to do what I was told And That's not how I operate. good I was a good employee and I was a very good nurse practitioner, but I didn't like being told what to do And so I recall that entire pregnancy with my second son She and I were arguing a lot. And I recall at one point talking to the supervising physician and saying This is not healthy for me as a pregnant female to be under this much stress for a part time job. It's like, let me be clear I was like, I'm very good at what I do, but her expectations are a little bit ridiculous. And I remember he actually had to step into these conversations because I felt like she wasn't listening to what my needs needed to be. It was not reasonable to ask a pregnant female to work at a hospital thirty minutes from her house and then turn around in the afternoon and see patients in an office thirty minutes in a second direction and give me no time to eat. Like those are the types of things. we would She was like, you can eat in your car. I was like, while driving, I should be eating in my car while driving. So was those kinds of things. And that may seem trite now and I can laugh about it now But what's interesting is that child, who is now eighteen in the past year had some healthca care hiccups and is seeing a wonderful functional integrative physician And when we did testing on his adrenals, guess what was not optimal And so in the back of my mind, of course, every mom thinks this, I was like What was different about my pregnancy with this child than my first child And I absolutely believe each child is unique. Each child is different My second son is wired very differently. His stress levels rev high. He's a very intense kid. He's at a very demanding high school, and that's by his choice But when we started looking intrinsically at his lab work And I said to this physician, friend of mine I was like, I'm a thousand percent certain that the stress that I haven't even disclosed all the things, but the stress that I experienced while I was pregnant with him at work battling with this particular person, at least had some impact on his adrenals at this point. And he said, I don't disagree with that And so I share this because we as women, what do we do? We blame ourselves all the time. And I always say like, you know he is managing his adrenal health and his health beautifully with no, you, long term negative effects. But in the back of my mind, I'm always thinking You know, when we talk about the interplay of adrenals and immune system and stress. I always think about autoimmune stuff And so that's always tucked in the back of my mind because I know for myself personally, I've had multiple autoimmune conditions, which has a great deal to do with how I grew up And so I'm very sensitive to that Let's talk about how this interplay of stress. even suppressed things. You know, so many of us are super high functioning But when we're talking about this interplay between stress, chronic stress, The immune system and autoimmunity, how does that play up? How does that show for your patients? How do you think about autoimmune conditions because even now They're talking about how PCOS may not be this just metabolic issue. It may actually be Autoimmune issue as well Well, I think it's important because I have had patients who've come to me that've been working with other practitioners and they'll say to me, I know my testosterone iss low because I'm exhausted. And I'm like, Okaykay, well let's test Their testosterone is fine. It's their cortisol. Yes that is really low and it explains all of the symptoms they are experiencing. So it's usually not just one thing. But I think one big theme that I think is important for patients to understand is what's going on with the adrenals in perimenopause because I think this is those coping mechanisms that you were alluding to at the beginning, like to get up and go, get shit done in your teens, twenties and thirties served me very well. Ver, very well as a type A high achieving person did not serve me well in my forties because the, you know donon't sleep enough, over exercise, put myself under so much stress, getting things done wanting to ear in many ways. I don't think it was so much that I wanted to appear perfect. I held myself to high standard. Yes. Y. Let's talk about what is going on with the adrenals as we are navigating middle age because this is such an important kind of overarching concept for everyone to understand because we always need to be doing things to nourish adrenal glands. Yes. And which is part of, I'm sure a lot of people have heard, you know former guests in social media at the nervous system. This is your nervous system. And it starts in the brain. So we have two parts of our brain, the hypothalamus and the pituitary And they are what the hypothalamus takes in all the input from everything happening in your life. How much you sleep you've had, how much you have or haven't had to eat, how much caffeine you've taken in, what you've been exposed to that day, what your schedule looks like If you've been fighting with somebody or not like that, hypothalamus takes all of that in and then dictates down to the pituitary in your brain. And then that goes down to the adrenal glands and says, make cortisol, or you can even make adrenaline, which is epinephrine, nor adrenaline, nor epinephrine. And there's a different layer that does make testosterone and makes also DHEAS. so some androgen hormones So depending what you need, the brain dictates everything, goes down to the adrenals. Once the ovaries are done, you still can make some testosterone out of your ovaries also make testosterone, as I said, out of your adrenal glands So if you have been burning the candle at both ends. If you have been really stressing out that nervous system, if boundaries have been a struggle for you, you've been people pleasing, you haven't been saying no and I'm not saying this to blame anyone, what I'm saying is we tend to have the realization as we go through perimenopause of like, wait a damn minute. hold on. This isn't working for me anymore. And so what happens is this system, the HPA acis is what we call it, the nervous system says I'm not as good as I used to be. L I'm having a hard time keeping up. The brain is trying to protect you so it might even down reggulate your cortisol. You might find yourself Really just burned out low cortisol because the brain's like, girl, stop. rest, take a break. need to be We need to survive for a minute. We need to be more resilient, but I don't even have the reserves to give you resiliency. And so what I find is that a lot of women actually kind of slide in sideways to perimenopause and then they're like, I used to be so good, right? I used to be so good in my thirties and now I'm completely burned out They're comparing themselves to their younger years and all the energy they had and all the ability they had. like, yeah, your system is ively trying to get you to slow down rest and heal. And we don't as humans, we keep pushing, pushing, pushing. But what that translates to when we have this nervous system that's screaming for help is that it shows up in other areas of the body. Our hot flashes and night sweats are work worse.ur sleep doesn't work as well. We tend to gain weight. Our skin gets thinner and looks older and drier. Our hair starts to fall out and get thinner. We're tired. That affects our mood. So now we're grumpy or we're irritated, or we're anxious. I mean, it can affect our periods. If you were ovulating whichich can still happen in perimenopause. Maybe you find your're ovulating less. Is it age? Is it stress? We don't quite know yet And so all these downstream symptoms can happen When the nervous system's like, please stop Stop and take a break just for a minute. takeake a breath Well, and I find a lot of the women that you know, course correct and Back off on the intensity of exercise, get more sleep, adjust their diets, do the right types of exercise, ennsure they are surrounded by healthy relationships as much as possible Maybe they change their job. I mean, there's so many layered components to this I think those women can go on to course correct and thrive through the rest of perimenopause and I speak from personal experience because I did everything wrong I didn't know any better. No one prepared me for perimenopause. I kind of hit it like a wall. and I remember there was an entire year in my forties that all I did was walk. I went out doing fiveive AM intense conditioning classes and spin classes to just walking for an entire year because that was as much physical activity as my body would allow me to do And I think for so many women listening because these women end up in our programs and we interact with them. So I know there's a lot of us out there that course correction can set you up for success throughout the rest of your middle ages and and beyond. And I think that in many ways, there's this thought process, o, you're being punished you're doing something wrong and really the word pause, whether we associate it with middle pause, perimenopause, menopause, thyroid pause, adrenal pause, whatever terminology we want to use The word pause needs to be the emphasis Something I hear constantly from women in our community and something I understand personally is this. Nothing about your effort has changed and yet our bodies are responding differently. Your midsection feels different, Y blood sugar is much less stable and your cravings may have shifted And let's be honest, your energy probably isn't what it used to be As a nurse practitioner with over twenty five years of experience, I want to be completely transparent with you about why. Estrogen is one of the body's master regulators of metabolic health. It influences how we store fat, how our tissues respond to blood sugar changes, and how efficiently our metabolism functions at the cellular level As estrogen shifts during perimenopause and menopause, the same lifestyle choices, diet, exercise, sleep genuinely do not produce the same results. This isn't a failure of effort. 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This is a targeted cellular support for the transition we are all in and's designed specifically for women in perimenopausea menopause and built around what actually is effective Go to wWW dot mitoQ dot com slash Cynthia and get ten percent off your first order Again, that's mIT oQ dot com slash Cynthia to get ten percent off your first order When we talk about perimenopause and menopause, the conversation often focuses on hormones. And let me be clear, hormones absolutely matter But one thing I think we don't speak enough about is muscle Women can lose significant muscle mass and strength during the perimenopause to menopause transition, and that loss impacts far more than just our appearance Muscle influences metabolic health, insulin sensitivity, mobility, healthy aging and more And the good news is there's so much we can do about it. Strength training and adequate protein intake are critically important. And increasingly, we're learning about the role mitochondrial health plays in maintaining muscle quality as we age That's why I've been paying attention to the science behind Might Aure from Teline. Mitipure contains Urealithin A, a clinically studied nutrient that supports mitochondrial renewal throughrough a process called mitophagy Think of it as supporting the energy systems that help keep your muscles functioning at their best For women who want to remain strong, capable and resilient for decades to come, this is an essential area of research worth knowing about Visit timeline. com and use code Cynthia for twenty percent off your order. Again, that's timeline d. com and use code Cynthia for twenty percent off your order This is one of my foundational supplements that I never miss Yeah, So it's interesting to me. it's our modern day lifestyles that drive a lot of this disconnect for our bodies. And I know what I got away with in my twenties and thirties, especially as, you know, working in ERs, trauma bays, cardiology as an NP would not be the healthy environment for me to be in at this stage of my life when I'm already a little overly amped up type A personality. Let's speak a little bit to this GABA urgic system in the body that You know, you speak to as a very important way to regulate neural activity. We're really speaking to this neurotransmitter of GABA. It's inhibitory neurotransmitter. and I feel like you know, probably well intentioned, many individuals are probably taking GABA supplements. and we were speaking before we were recording about it's such a large molecule that it actually doesn't cross the blood brain barrier. Let's speak to GABA and why it's so important and why so many of us that are amped up, as you say, sympathetic dominant, really struggling in this modern day lifestyle to support our bodies in a better way. Well said and great introduction. The GAB urgic system is your brain's braaks justust like the brakes of a car. It's the same kind of deal We need to have the brakes on the firing of our neurons so that we can calm the firing of our brain. GABA is the most important neurotransmitter, so the brain chemical, the brain compound that does this now The other neurotransmitters get most of the press, the what we call the superstar neurotransmitters, things like dopamine and neurpinephrine in Serotonin But it is GABA really that rules them all because what GABA does, it, again, calms down the firing of the brain, but it's also what it's called an inter neuron, so INTER, meaning it's kind of like the wayay station. It's a gate. It prevents and regulates information that comes from the environment into your body. So your sensorium, things that are going around you if we were Bringing in everything from the environment that's around us at all times, we would be overloaded What Gab is able to do is really help calm down and gate that information. So it's extremely important for information processing, for skill acquisition for learning for memory Gabin neurons are all over the brain And they change depending on what's required in those particular areas There is called the GABA A system and the GAabBA B system. These are different the two major types of GABA receptors in the brain And the GABA receptor is extremely interesting, right? What it typically does is it's usually on so there's usually if you think about two neurons together, one's called the presynaptic neuron, one's called the postsynaptic. So the presynaptic is one that fires the signal. The postsynaptic neuron is the one that grabs that signal and does something about it when most the GabA A system specifically, this receptor inside that neuron prevents the postsynaptic neuron from firing So it has this capacity to be activated, It activates by GABA binding to it. And then when GABA binds to it, it prevents the firing of that neuron So as a result of that, you get the decrease in firing overall. GabA B works a little bit differently. It works with the presynaptic and postsynaptic together, but in essence, the same thing happens, which is that you stop the firing of your brain. The problem, and we were kind of alluding to this already, Cynthia, is that so many of us are actually GABA deficient. And it's not something that clinicians like me or like you are really looking for because it's not something that's know taught in medical school or even thought about really in clinical practice But the issue, the problem, is that when you're looking at GAabA deficiency, GabBA efficiency is so common It's associated with things like depression It's associated things like insomnia Anxiety Tremers and so many more conditions that are very common. Like many people are coming into the doctor's office and say, I don't feel good. I have depression. My mind won't stop. and I have anxiety or I can't sleep. And you know it's also associated with mental health conditions like even schizophrenia and bipolar disorder are associated with GABA issues. But when you go to your doctor and say, you know, doctor I'm feeling anxious all the time, I don't how calm down. They're going to give you an SSRI or something like that, right? And so the problem and we know this is that, you know, depression is not a serotonin deficiency This has been recently published in the last couple of years. They looked back and retrospective studies and looking at serotonin levels in depressed patients, and their levels were not lower than the average person without depression. So it wasn't just like You know, that you just would give someomebody an antidepressant because they were serotonin deficient. and you could give them this SSRI and it would help it would help them. inccreasing serotonin could help them But it wasn't the major underlying reason for why they were depressed. Gabbot, on the other hand is shown directly to have correlations with, as mentioned, depression and anxiety. And a good example of this is that the average human has about seventy thousand thoughts per day. Now, if you are anxious or depressed, that number goes up to one hundred twenty thousand thoughts per day That sounds like a lot of thoughts. It is a lot of thoughts. And even on average for seventy thousand, that's a lot of thoughts, right? So I always tell my patients and my friends that'll listen to me or my wife sometimes when she listens to me, that You don't want to believe or my kids, you know, that you don't want to believe everything that you think, right? If you believed all of those seventy thousand thoughts per day, like you'd be in serious trouble, right? the key to think about here is that we need to be thinking about the GABA system because it's correlated with all of these, you know potential conditions and there's so many things we can do to support that GABA system, which in turn is going to support your parasympathetic restest, digest, recover and detoxification systems I guess so much about perimenopause, like kind of the harkening of perimenopause is this de evolution, this ovarian senescence of less orgestterone being produced in the ovarieses And so progesterone and GABA really do interact with one another. Let's speak to that because I find this so, so interesting. And I think for many listeners that are experiencing an up reggulation and anxiety and depressive symptoms and more insomnia or trouble falling or staying asleep at this stage of life This complex interplay between these two hormones is very important , it's huge,' huge I' glad mention, because It's you know, progesterone is directly increasing gabatone. So when you have more progesterone around, you will sleep If you don't have as much progestan around, you arere not going to sleep as well. That's just how it goes. And you'll actually notice this if you're still having,ir reggular periods that you'll notice at certain parts of the times of the month, You'll sleep better than other times. and this is when you're more progesterone dominant versus when you're more estrogen dominant. So typically, earlier in your cycle, when there's more sort of estrogen predominance, you're going to feel more awake alert because estrogen actually has the opposite effect. Eestrogen is it blocks the GABA receptors. So you feel less tired, typically, you can go on less sleep overall and you feel pretty good, especially around ovulation. But when the progesterone starts being more know on the balancing higher than the estrogen, that's when you're going to need more sleep. You're going to feel like you need, an extra thirty minutes in bed. You can't get out of the bed in the morning and things. But this is very important during the perimenopausal mopausal time because this is one of the reasons Wh women will have a much harder time sleeping it's so important to support the GABA system in this capacity, right? I mean, of course, giving progesterone is an option and that depends on the situation. And of course, you know, what your perspective is on HRT and things like. But in essence, at least for me personally, I think it's a good idea, but along with, know, a battery of other things, but my Overall perspective is here is certainly HRT is something to think about, but how are we supporting the production of GAabA? or are we making sure that you're not depleting it as well. I mean, one of the major things that's depleting it all the time that all of us kind of know this, you know, intuitively is stress, right? So if you're always stressed, if you're always you know, your cortisol, which is like your stress hormone in your body, it's your steroid hormone. steroid hormone or us all depletes GABA in the system. And so it also depletes some of the coactors, which are these other things like B six and magnesium specifically, that are responsible for the conversion of GABA from its precursor. The precursor to GABA in the brain is something called glutamate. Glutamate is our excitatory neurotransmitter. In fact, It is in combination with GABA, the total between the two of them is eighty percent of your brain's neurotransmission. Okay? So the rest of the other ones, neurpinephrine, dopamine, sererotonin Only twenty percent compared to glutam and Gaba But glutamate, in which is super interesting is that the way we've evolved is that glutamate is our excitatory neurotransmitter And GABA is are inhibitory, right? And there's always going to need to be a balance between these two. And there has to be conversion of these two from, you know, from glutamates to gab, I you need B six and magnesium to do this. So if you're B six or magnesium deficient, you're going to have a hard time making that conversion If you're actually not making enough glutamate in the first place, then you're going to obviously have a hard time, you know making enough GABA. If you're depleting GABA so fast that you're having a hard time making that balance shift fast, then you're going to get a glutamate over abundance. And then what's that going to happen? It's going to be like this, you know, it's like that downward perpetual cycle spiral where you're stressed and then you can't get unstressed And you feel worse because you don't have enough of that, you know, that gaba there and you have too much glutamate around. I mean, the most common example of this that people kind of know of that they've had the experience is that you go to a Chinese restaurant and you have MSG in your food. MSG is modosoddium glutamate And this is a direct source of glutamate to your brain So this is why you get headaches, you feelar irritable, you can't sleep all of a sudden you have this over abundance of glutamate in the brain This this is happening to all of us on a regular basis just because of anxiety, stress, nutrient depletion. You know gut issues can do it too. if you have a leaky gut as well if your gut's not working very well. The main The fuel for the small intestine is something called glutamine, which is an amino acid. and includ glutamine is also the precursor to glutamate in the brain. So as you can see, this is all connected, but the key here is to understand that, you know, if you're gabT efficient We have to support that system I love the analogy and that really hones in, especially for listeners maybe who are not prescribers, the difference between milligrams versus micrograms. And what's interesting to me is in the ability of like, you know, I'm on hormone replacement therapy. I know take thyroid replacement. right now I'm on a bunch of peptides to fix my gut and support my immune system. And that's another day. I'll talk to listeners about that. But The point that I'm making is you really are at the beholden nature of each compounding pharmacy and there are good ones and there are not so good ones out there. And so hopefully, if you're working with one, you've had great experiences But having said that, You know, it is like you don't want your pharmacist being asleep at the wheel when you're talking about micrograms of medication. I a hundred percent agree with you No' I think we'd be remiss if we're talking about that without talking about adrenal health. and I think this is Kind of kissing cousins, but in many ways, I feel like adrenal health really doesn't get sufficient emphasis I think the term adrenal fatigue has gotten so many traditional allopathic providers completely triggered. And yes, I think there's other ways to describe what's happening physiologically to women as they're navigating middle age and beyond So let's talk a little bit about adrenal health. What is your overall kind of gistalt, your perspective about How you work with your patients, how you support their adrenals, because we all know as we start navigating the early stages of perimenopause, our adrenals have to be supported not just them, but throughout that second half of our lifetime Absolutely. So You know, I'll start with the fact that Almost one hundred percent of our patients need their adrenals addressed. And if I give someone perfect thyroid function and I do not address their adrenals, they don't feel the improvement in their thyroid. If I fix their adrenals, but I don't address thyroid dysfunction, they don't feel that improvement either. They are so intricately intertwined give someone their actual life back, their full sense of vitality. you need to address both. To back up a little bit, know, our adrenals sit on top of our kidneys. They're responsible for our stress response. They secrete cortisol, stress hormones, but that also helps to regulate our sleep wake pattern, how we feel when we wake up in the morning, our energy, our clarity throughout the day. They are a huge role in our vitality. And medicine views our adrenals as working perfectly or in one hour, in one day, in one moment, they both completely stop working and then we're in adrenal failure. It's either or and I've said that for years. I actually heard an endocrinologist say that exact sentence on social media within the last six months. I was like, wow, you said that out loud And you didn't realize how impossible that is. L, wow, okay, so you really do believe that. So that is not how normally things work in the world, much less our physiology. There is a slow breakdown over time For sake of the convenience, we've termed that adrenal fatigue. It can be adrenal dysfunction, whatever it is. But it's not adrenal failure. It's not Adison's, and it's not perfect adrenal function. It's somewhere in between. And it drives the similar symptoms on the continuum of adrenal failure, but much less severe, obviously. And so it's in my opinion, it's a very real thing. I see it change people's lives when we address it literally every day and When you have low thyroid, your adrenals are trying to compensate. So because they are connected and so intimately related, they make up for the other one constantly. So someone that's had thyroid dysfunction for ten years, Their adrenals have been overworking for ten years And like anything that we over use and overwork eventually it gets worn out, it gets tired. And that's what we term adrenal fatigue. And I am a huge huge proponent in the diagnosis and treatment of that Yeah, it's so interesting because I think that for every woman listening north of thirty five whether it's acute stress, chronic stress you have to be attuned to stress management because your adrenal glands can work with you or against you. And I always use myself as the example and not just mention my own personal experiences over the past year, which has been like way more everyone has stressed, but way more stress than I would normally experience An anytime I'm talking to a patient who's gone through a divorce. They had a big move. someomeone lost a job Someone in their family got sick. Maybe they had a major life milestone. A kid got married, graduated from high school, college, et cetera Always have to buffer those life experiences with additional adrenal support. And that can sometimes look as simple as you lifestyle adjustments, but also could be nutrition mediated, It could be sleep mediated, It could be adaptogenic herbs could be sleep support. There's so many things Do you have favorite supplements or favorite strategies that you like to use with your thyroid patients to support their adrenals Oh my gosh, yes, I'm so glad you asked me that question. Okay, so obviously the lifestyle piece is important, right? Like you have to rest your way out of adrenal dysfunction. You can't push your way through. So my over exercisers, my really type a business women, hardcore moms just going one hundred miles an hour, you've got to rest. So you have to compensate for this work that you are putudting on your body, takeake a nap when you can. If you have the ability to do that and you're tired, do it. Get enough sleep Get enough salt, your adrenals need salt. If you notice you're craving it, that's why. Right? Th thoseose are kind of some basics, meditation, stress reduction, all of those. do not over exercise Most important thing Do not over exercise. It is the most intensive way to break down your adrenals. So only exercise to the degree that you feel just as good later that day or more energetic, never depleted, never sick, never need a nap That's a good sign you're overd doing it. My favorite supplement of all time. of anything of any category is orrtholecularars adrenal. It works better than any adrenal supplement I've ever tried personally or with my patients, it has a blend of things that help kind of nourish and restore your adrenals, but it also has cow adrenal gland in it. So basically like armor, like desiccated pig thyroid. We are giving your body what it's missing So one, we're taking the workload off of your body allowing it to rest its way out of the situation, but two, you also don't feel like you have adrenal fatigue It is incredibly life changing. So that's my number one. I also do use Ashwag Gandha veryery, very frequently with my patients, and it's fine to take when you have a thyroid issue, even if you have Hashimotiv's unless you are on an absolute extremist diet, which I don't recommend doing anyway because then you're just further taxing your adrenals. So those are my two favorites, but certainly adrenal Yeah, orrthamolecular has amazing products and I love that you mentioned, you have to rest your way out of adrenal issues and I think that that is a huge issue for so many high functioning women. Maybe these are women who are at the sea level, Maybe they have just really demanding jobs. They're, you know dealing with extremes, their parents are getting older, their kids are teenagers. They just have a lot being thrown at them. I also kind of think about the women that I call it the triad, but it's the over exercisers who overrestrict food, who also over fast. And inevitably I get asked, can you safely fast if you have thyroid issues? My answer' typically it depends, it depends. Is your thyroid function stable? How are you feeling? But when you're looking at that kind of triad, that constellation of symptoms Those women in particular, I feel like have the hardest time. I always say perienopause and menopause, the pause is there intentionally. We really It's a time to recalibrate. it's a time to re investigate. It's a time to really look at our choices Do you feel like you probably have women in your practice that are like that as well? How do you kind of coax them out of those kind of extreme Extreme of extremes on every level in terms of how they look at lifestyle and exercise and nutrition Yeah, you know, I've got a lot of those women, you know, probably because they come to me. I'm sure they come to your programs and care as well because they've tried everything and it's not eliciting the result that it's supposed to. so they just keep doing more, you know? And it becomes really dangerous. I mean, truly, some of the only people that we can't fix at modern Thyroid Clinic are those exact people And for these women I think this is not discussed often enough and it's certainly not building enough awareness. So younger women hearing this or their family members, helping them understand that chronic long term stress can hasten ovarian senescence, ovarian aging or ovaries We're born with a finite amount of eggs. by the time, you know, we hit You know, our forties, we have a lot less eggs than we were actually born with, but we know that stress over time can exacerbate this. I think a lot of hormonal shifts interact with that stress response. So like for example, vasomotor symptoms, you got your hot flashes, your night sweats, which we're all really familiar with. I think we know that's tied to this hypothalamic thermoregulatory instability that's going on and those also kind of interact with those stress pathways. We know that during this time frame like there's that decline in that estrogen and progesterone, and that really kind of affects that hypothalamic pituitary access and our autonomic nervous system. It's all kind of intertwined in there. So when that's all going on, it increases our invulnerability, it increases our sympathetic overdrive. fight flight respse. And if you live in this constant state of fight flight, you're releasing lots of cortisol. I don't love the word adrenal fatigue because and I actually was listening to McCall talk about this on your podcast a couple weeks ago that we either have this, you're fine or adrenal failure. And there's nothing in between, and I don't love adrenal fatigue. We need a better word for between nothing and failure because there is this middle ground, but kind of in Western medicine, no one wants to accept that. And I think when you're in this huge sympathetic overdrive and that inccrease fight flight. Of course you're in this middle ground. You're not in failure, but you're certainly not normal. Yeah, and certainly not optimal. I think that's really ultimately what it comes down to. and You know, I think for the benefit of listeners, when we're talking about these changes in the autonomic nervous system that are driven by changes in sex hormones, let's talk about the interrelationship between estrdiol or the predominant form of estrogen and our serotonin levels, which can impact You know, how we view the world, how we perceive ourselves, how we sleep, how do we interact with loved ones? Absolutely. And what I think is super interesting when we kind of think about that, we know it's kind of declining. We know that estrogen is kind of more than just this reproductive hormone. I think that that's kind of one of the most important things to point out. My colleague, as we all know, doctor Mary Claire Haver always says like this estrogen decline and perimenopause is a state of tootal chaos that's going on in the body because estrogen acts more than reproductive. It kind of is this neuroosteroid in the brain. We know it's in the brain, the research is there. We also know that it kind of works with serotonin, it works with dopamine. and as it starts to decline, why are we seeing insulin resistance, metabolic syndrome, all the things We know that estrogen is really important for that serotonin synthesis, kind of decreasing that serotonin breakdown. And then we know that it's really important to kind of even kind of acting in that The way I like to think of it almost like when we think of the little pink pill that's called Favancerin, it's kind of what we call this five HT two A receptor agonist antagonist. Estrogen kind of almost acts in that way where it can increase some of those receptor responses and decrease kind of in that prefrontal cortex, hippocampus type things. and I think it's kind of really important to see like this whole neurore reggulatory thing that estrogen is doing. because a lot of times we think of it as, oh, it's just a sex hormone. It's just in your ovaries, but it's so much more than that Yeah, I think in many ways, you know, Tom Day Spring called it bikini medicine that for a lot of providers, they think of estrogen, progesterone, testosterone as these bikini medicine related hormones. And he said, you know, it affects every system in the body. Every cell in the body is impacted by these sex hormones. So is it any surprise that as women are navigating this hormonal chaotic environment in perimenopause that they start to not feel like themselves. They start to feel like they view the world very differently, that they don't understand why their sleep has suddenly gotten very poor. They become less stress resilient. Their body seems like they're like, I'm outside my body looking in and saying I'm doing everything I used to do and nothing is now working. I think for so many women, it's Fustrating to navigate in a system In the medical system where a lot of providers are actually never trained in what women are going to experience in perimenopause and menopause. and a big thank you to you and so many others that are building greater awareness around this. When you're talking to your patients just to kind of back up and talk about the adrenals, and I agree with you, adrenal fatigue is not an appropriate term at all What is one of the most important things that you like to emphasize with your patients to help support their adrenals as they are navigating this middle agge time frrame? I really so one of the big things and we've been hearing it from other people talk about it as well, one of the first questions I ask them is what does exercise look like for you? Because we also have to flip the mindset. All the GLP drugs that are out there, they're wonderful. There's a lot of anti inflammatory things that they do. Forgive the word, but microdosing. I don't love the word because again, it falls in that adrenal fatigue category There are true benefits of it, but then it also has now shifted that mindset of, oh, GLPs I can get skinny. It's the Hollywood drug, and it's still all that implication of people taking these drugs to kind of be skinny. And so maybe it's gotten away from this crazy exercise phenomenon, but where I'm going with this is that Back in the day, it was like, eat less, exercise more, you'll lose the weight. Now it's like, okay, shoot yourself with the injections. Maybe you don't have to exercise. So that is a whole other day's discussion, but with the exercise, it's one of the most important things I talk about on my midlife women because they get on this hamster wheel, like I'm not losing weight, I'm having more mental abdominal belly adiposacity. They don't really understand this whole insulin resistance that happens when our estrogen declines, the metabolic syndrome And so they're exercising more. They're doing tons of hit or more cardio. And I think that we're seeing more and more that people like us that are going in and trying to give knowledgeable evidence based advice is that we're coming at it from, no, you don't need to be doing crazy cardio. You need to be lifting more. You need to be taking rest. You need to be focusing in that zone too where you can have a conversation and not feel winded because that's super taxing on their adrenals and on their stress response. 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Please support our show and tell them We sent you I'd love to pivot a little bit and talk about the role of circadian biology and the microbiome Because as someone who used to work shifts, I'm sure that you had many nights, you were up all night or doing surgery in the middle of the night, I think for a lot of people When we go against nature, when we go against the way that our bodies are designed to be asleep when it's dark outside and awake when it's light outside talkal to us about how circadian biology influences the health of the microbiome for good or for bad. And I'm speaking specifically to Jet lag Shift work, you know, a lot of the EMS healthcare professionals that are up, you know, bus drivers, police officers, people that are, you know, their entire circadian biology is shifted due to occupational demands Number one, God bless our shift workers, our nurses. health care providers, firefighters police officers who basically take this on. because working shifts has been associated with poor health So there is a sacrifice that is being made and it is for the same reason that when you fly and you change time zones, you don't feel well. That's jet lag and that is disruption of your circadian rhythm. And it is for the same reason that when we have daylight savings time It's only a one hour shift And it messes with your kids and it messes with you. It's only one hour And just think like Cynthia What the heck was I doing in college when I was like staying out till two in the morning On the weekends, right? That's like a five hour shift, maybe not five, but like that's a multi hour shift from my normal spedtime So these are all examples of the manifestations of circadian disruption And that's because our body was designed to have a daily itinerary. and to know what is happening when and to be prepared for that so that you're not constantly reactive But in fact, you are proactive. The body is anticipating certain events that are going to happen during the course of a twenty four hour calendar And it's able to build around that for optimal function That's why we have a circadian rhythm so that we can basically have optimal function during the course of our day And when you totally disrupt that The body is just like totally disoriented and only reacting to what's happening and it's just trying to catch up. The way that this works is it's built around naturally the rise and fall of the sun because that is the thing that basically sets the tone of day. and night and every life on this planet evolved with that on some level including the microbes that are inside of us. because they get influenced too So even though it's not directly the light that is affecting them, it's indirectly the light because Blue lightite Hits our retina in the morning It activates the SCN, which is the superchismatic nucleus. which is the very first vocation in your brain that you could actually get information from both eyeballs. It's like literally in that first spot. And it sets off a physiologic response that affects the entire body with the release of cortisol, which is the stress hormone cortisol in the morning It' not thing In fact, it is a good thing the morning is a good thing. we hear about stress Youar about the stress hormone and you say o Oh, that must be bad. Yeah, it's bad when it's three in the morning, and it's keeping you up That's not the way that your rhythm is supposed to be. threeree in the morning is when you're supposed to have the least cortusll in your body But then when you wake up in the morning, you get the spike and that sunlight that you get, when you go outdoors, again, most of us are not doing this. We're indoors You go outside You get that sunlight exposure, you boost it by fifty percent And now that quar is all. I want the listeners at home to contemplate this Think about the focus that you have in the morning Is it not your time of best focus for most people Think about the energy that you have during the day. That actually is the result of cortisol. Cortisol is our get up and go hormone And this light exposure also helps to increase our serotonin production which you think about this time of year, seasonal effffective disorder because we're not getting enough natural sunlight outside So all of these things start to basically lock in. And the key here is that the serotonin cortisol other elements of your natural daily rhythm putting the food that you eat. are going to impact your gut. And the evidence indicates that more than fifty percent of the microbes in our gut, they're on a rhythm too They are rising and falling literally during the course of a twenty four hour period so that they can meet the moment And what that means is specific functions at specific times during your day. And the more that you create consistency the more that they will learn. And they will be there for you to step up in those moments and to help you. and the more disrupted that you are They have no clue what's happening So you can't expect them to be organized and prepared if they don't know what the itinerary is. So this is why consistency becomes the word of circadian rhythm. If we can create consistency in our life around wake time bedtim around morning white exposure around our meal times. If we can do those things, then we can really power our health in a beautiful way. So eloquently stated, just to kind of round out the conversation today One of the things that stood out in your book was the role of fiber equating to better sleep. I think for so many middle aged women who are struggling with sleep, it's very much multifactorial. It's never just one thing. But I love that you spoke about the importance of fiber and how that can influence the quality of sleep that we experience There's specific microbes that are associated with insomnia And there are specific microbes that are associated with more restful sleep. And it turns out that the microbes that power better sleep are increased when we consume more fiber. But I do think that there' also an inflammation story behind all of us And when we are in an anti inflammatory state, then we can naturally tap into these rhythms in a more powerful way that includes that morning cortisol, that includes melatonin in the evening to fall asleep And when our gut and our body is inflamed, then it's naturally going to make things fall out of balance. And it's going to disrupt our sleep and the quality of our sleep is reduced. you're more likely to Wake up in the middle of the night, have racing thoughts, not be able to fall back asleep These are indications of being out of rhythm So absolutely yes, fiber is an opportunity for us to enhance our sleep. By the way, there's a Sarotonin story to that as well which is that So I mentioned that serotonin is the happy hormone And it not only powers our mood, but it also affects our ability to focus our energy levels during the day but also in our gut, where ninety five percent of our serotonin exists Serotonin is setting the rhythm. of our God And when our gut is in rhythm, we have good, healthy, fantastic bowel movements. And when our gut is out rhym This is how we end up with constipation or with diarrhea And it's no coincidence that Menopause is associated with, particularly constipation for many women It's not a coincidence Saratonin can be enhanced with fiber consumption. can also be enhanced with light exposure. and can be enhanced with tryptophan, which is one of the amino acids And when you do that, you create more serotonin And here's the really cool thing Serotonin precursor. to melatonin. So Serotonin we produce in the morning In fourteen hours becomes melatonin in the evening. And when melatonin is in the brain, you enhance your ability to sleep fall asleep, to have restful sleep, to have high quality sleep and wake up. restored and refreshed the fascinating thing is that our gut has four hundred times more melatonin than we have in our brain. It kind to make sense when you think about ninety five percent of serotonin is in our gut All if that flood of serotonin is being converted to melatonin. But what's it all doing there Overnight whileile you sleep thanks to the melatonin in your brain You have melatonin in your gut that is repairing and restoring your gut barrier And this at least in part explains why We have research studies with melatonin supplements. indicating that they can have an anti inflammatory effect and also indicating that they actually are good for acid reflux and other digestive health conditions Well just thinking about You know, women telling me, you know, they're in perimenopause or menopause. they're starting hormone replacement therapy. And I would say eighty percent of women start it, they feel great Maybe their weight stabilizes, maybe they lose some weight. And then there's definitely And this is relevant to our weight conversation. There are women who say, I got put on HRT and I gained a bunch of weight And so I'm sure It is not that they did anything wrong. It's that their body's way of metabolizing and processing these hormones might be very different. Maybe this is someone in precision medicine who needs a lower dose to start. Maybe this is someone that needs to have a different type of hormone. maybe instead of Mostly estrodiile, maybe they need a weaker form of estrogen. So I'm just thinking from what you're sharing Yeah, trying to connect the dots because there's nothing more frustrating as a middle aged woman being told, you need hormones getting put on hormones and then you gain weight. That is very frustrating So genetics is not an absolute answer. You know, we're not diagnostic. We're not saying genetics is the only answer You need to just think of it as I know it's so cliche to say it, but It's a piece of a puzz It's a very big piece of our puzzle, right And so I want to give you some more examples. Can we talk about mood Exiy Ture. I mean So there's two sides to it. The one is genetics and the one is epigenetics. So let's think about genetics. So we have these neeurotransmitters, which are essentially brain messages Don't go me and Sar aone then Adrenala andor adrena, but don't mean Saraton are probably the two that you know the most. And they really define to a large degree our experience of this world and whether it makes us feel better or makes us feel worse. And by wors, it could be anxiety, it could be depression We also can talk about addiction, but that's not con. It's the same conversation where Why aome so much more susceptible to an addictive perine. not can be drugs, it can be alcohol, but it can be carbs and sugar. It can be exercise. It can be sharing, it can be shoes. So it can be any of these things, right? It can be OCD behaviour It's because Our genes and their spelling changes are going to change the way we Metabolize, convert and break down these brain messages. So that they is a situation where we are very, very good. We speed up the way the body breaks down dopamine and serotonin, which means we have low levels of dopamine and serotonin, which means we' more susceptible to depression Low energy Fatigue It can also work the other way and say, well, actually The enzyme' not good at breaking down dopamine serotonines so actually stay in high levels and high levels can be Inomnia Restlessness, anxiety. So when we're thinking about what our experience of mood is and we discussed many different versions of mood, We really want to know how our genes are impacting those neurotransmitters because the decisions we make about the intervention we get given, the treatment plan, the medication we may or may not going, the supplements we're going to use the sleep hygiene that we plan, we really want to know what is my body doing with these? Because I don't want to take anything, whether it's natural or pharmaceutical is going to increase my dopamine and serotonin if I'm not breaking down dopamine and serotonin. So I wish that We want these insights. We want this information because we're also different. Now the epigenetic conversation which I lived When I started out in genetics, I only believed in my naivety that nutrition, exercise, and maybe toxins change our gene expressions, which on is vit. Now I have this beautiful slide that shows how everything changes gene expression. But I just want to mention it in relation to anxiety and depression so tenon is connection Community That conviality, sharing a meal So whenever I go to conferences and I was recently at a conference where I met Cynthia, I call it my hug fest because I have all these wonderful colleagues that I've known forever and I just go from hug to hug to hug every time. I hug someone that I'm really happy to see I am switching on genes that are switching on my dopamine and serotonin and making me feel fabulous. It's like plugging yourself into a Donian wallplag and getting a supercharge So when we had COVID and we were disconnected, we were lonely, we were alone. We were working from home. We suffered greatly in the mental health bvent because we were not switching on these genes that give us more of these beautiful, pleasurable hormones and rather the opposite that we were suffering from despair of it. So that's why when we think about who we are and the decisions we need to make, we always want to think about genetics And we want to think about epigenetics. Oh, that's so powerful. You know, it's interesting. I've spoken at multiple events this fall and the event that we met at in Scottsdale, which was A four M. There were so many amazing people that were speaking peopleeople that attended, people that I connected with, and you're right. When you have that synergy Not only when you're hugging someone, you're releasing oxytoc, which lowers cortisol, which makes you feel great But that connection piece, I think, is so often forgotten and when we're having these more like technical conversations And yet we are social beings. And I remind individuals that loneliness If you look at it is as impactful on our health is smoking. And I think we don't talk about that enough. And I think about the impact of the pandemic. I think about older people, maybe that are retired, maybe they don't live close to loved ones. I mean how important that connection piece is. So I'm so grateful that you brought that up because sometimes we get so caught up in like, how much did you sleep? Are you managing your stress? Did you exercise? What are you eating? When we're looking at Maslog's hierarchy of needs That connection piece is equally as important as these other lifestyle measures Act I mean, that was a big a half for me, like really big a half for me. becausecause I was so focused on nutrition for so many decades. I didn't think about all these other things. The weather changes our gene expression, right So if you're a person who needs sand and you live in Seattle. I need to be really cognizant of the impact the weather is having on my emotional welling, but actually on all my genes And I need to put things in place to try and myself that medicine. So everyone loves sunshine. A actually my children don't love sunshine, Most people like sunshine, but for some of us, it's more important than others And so We need to think about every single thing Connection